Selenium Deficiency during Long-Term Management of Crohn’s Disease with Full Elemental Diet: A Case Report

Elemental diet (ED) is an efficacious treatment for patients with Crohn’s disease (CD). A full ED, Elental® (Ajinomoto Pharmaceutical, Tokyo, Japan), is often used for induction and maintenance therapy in CD patients, particularly in those with abdominal pain due to active CD with expansive ulcers and multiple strictures. Selenium deficiency is rare, but occurred in patients under longterm management with full ED, because elental does not include selenium. A 35-year-old man had received long-term full ED treatment since the diagnosis of CD. Symptoms of curly, ulotrichous hair, recurved nails, dysarthria, visual disturbances and sensory disturbances of the limbs were exaggerated. Serum concentration of selenium was below the detection limit of 2.0 μg/dL. He was diagnosed with systemic disorder caused by selenium deficiency. With continuous administration of sodium selenite, hair and nail changes and dysarthria resolved, but visual and limb sensory disturbances remained unchanged. The present case suggests that selenium supplementation should be started when distinctive symptoms associated with selenium deficiency appear in a patient receiving long-term ED.