Anorexia Nervosa Complicated by Acute Pericarditis, Spontaneous Pneumomediastinum, and Liver Injury: A Case Report

BACKGROUND Anorexia nervosa is a complex psychiatric disorder with profound systemic consequences, predisposing patients to potentially fatal metabolic, hepatic, cardiac, and pulmonary complications. This report describes a 21-year-old woman with anorexia nervosa presenting with acute pericarditis, pneumomediastinum, subcutaneous emphysema, hypokalemia, hypophosphatemia, transaminitis and rhabdomyolysis. CASE REPORT A 21-year-old woman presented with generalized weakness, pleuritic chest pain, and palpitations. Body mass index was 10.7 kg/m². Physical examination was notable for pericardial rub and extreme muscle wasting. Initial laboratory test results demonstrated hypokalemia (potassium, 3.2 mEq/L), hypophosphatemia (phosphorus, 0.9 mg/dL), and elevated transaminase levels (aspartate aminotransferase, 191 U/L; alanine aminotransferase, 308 U/L). Electrocardiogram showed diffuse ST segment elevation, and an echocardiogram revealed moderate pericardial effusion. Chest imaging revealed extensive mediastinal and subcutaneous emphysema (pneumomediastinum). No evidence of esophageal or tracheal injury was found on contrast-enhanced studies. The patient received cautious nutritional rehabilitation and electrolyte repletion, along with ibuprofen and colchicine for pericarditis. Over 2 weeks, her electrolyte abnormalities and liver enzyme levels normalized. A repeat computed tomography scan of the chest after 3 months showed complete resolution of pneumomediastinum and pericardial effusion. CONCLUSIONS This case underscores rare but reversible complications of anorexia nervosa involving the cardiac, pulmonary, hepatic, and metabolic systems. Clinicians should be aware that spontaneous pneumomediastinum and pericardial effusion can occur in severe malnutrition and can resolve with supportive care and nutritional rehabilitation. Recognition of these manifestations is essential for timely diagnosis, appropriate management, and prevention of unnecessary invasive interventions.