Pericardial Effusion and Elevated Liver Enzymes as Unusual Presentations of Severe Acute Malnutrition

Severe Acute Malnutrition (SAM) is a critical condition often seen in children from low-resource settings. While its common presentations include edema, growth failure, and immune dysfunction, rare complications such as pericardial effusion and elevated liver enzymes can significantly impact management and outcomes. To highlight unusual presentations of SAM and emphasize the importance of early recognition and comprehensive management. This case series describes two pediatric patients with SAM and rare complications. The first case involved a 1-year 9-month-old girl with edematous SAM, presenting with generalized pitting edema, fever, and loose stools, accompanied by mild anemia, elevated liver enzymes, and a minimal pericardial effusion. The second case featured a 29-day-old neonate with Pierre Robin Syndrome and failure to thrive, presenting with feeding difficulties, respiratory symptoms, elevated liver enzymes, and a small pericardial effusion. Both children were managed according to WHO guidelines, including nutritional rehabilitation, antibiotics, and supportive care, resulting in stabilization and recovery. Pericardial effusion in SAM is a rare but significant complication linked to fluid retention and systemic inflammation, while elevated liver enzymes suggest hepatic dysfunction due to malnutrition and infection. These cases underline the critical need for multidisciplinary care, early detection, and tailored interventions to address such complications. Healthcare providers managing SAM should be vigilant for atypical presentations like pericardial effusion and elevated liver enzymes. Prompt recognition and comprehensive management can lead to improved outcomes, as demonstrated in these cases