Selenium is an essential trace element that is known to be a component of glutathione peroxidase, a scavenger of hydroperoxides.1 Its deficiency causes a decrease in glutathione peroxidase function, thereby resulting in oxidative damage to many organs. The two major clinical signs in patients with selenium deficiency are skeletal myopathy and cardiomyopathy. White muscle disease, named because of its characteristic acolouration of the muscle is a myopathy caused by selenium deficiency in animals in the areas where the soil is low in selenium.2 In humans, it was demonstrated that Keshan disease, dilated cardiomyopathy in the Keshan area in China, was caused by selenium deficiency.3 In addition, there are reports that selenium deficiency occurs in patients who are nourished by total parenteral nutrition alone for a long time because of inflammatory bowel disease or resection of the intestine due to various intestinal diseases.4 5 We experienced a case of anorexia nervosa with skeletal myopathy caused by selenium deficiency under long term parenteral nutrition.

A 28 year old woman was admitted to our hospital with a 7 year history of anorexia nervosa receiving parenteral nutrition intermittently. At admission, she complained …