Salivary gland involvement, particularly salivary gland enlargement (sialosis), is a recognised complication in bulimia. We report the rare association of sialosis and necrotising sialometaplasia with bulimia in the same patient. The association of sialosis and necrotising sialometaplasia in the same patient with bulimia has been reported previously in two patients and may be coincidental, but the appearance in this additional patient suggests it may be prudent to explore this further.