Paradise Nut Paradox: Alopecia Due to Selenosis from a Nutritional Therapy
A 55-year-old otherwise healthy woman presented to the emergency department with a history of headaches, dizziness, vomiting, and abdominal pain for 5 days. On examination, she was conscious, rational, febrile (100 F), dehydrated, and visibly distressed. She was hemodynamically stable and maintaining adequate saturation in the room air. She had mild abdominal distension and diffuse abdominal tenderness. Other systems were essentially normal. She was resuscitated and admitted to the hospital. On the 2nd day of admission, it was noted that she had lost a significant number of scalp hairs on her pillow. This process started abruptly but was unremitting, and she noted shedding of hairs in tufts while combing or even gently pulling her hair. There was no scarring, atrophy, graying, or “exclamation mark” hairs on close scalp examination. However, even a gentle pull of hair caused painless extraction of a bunch of hairs, typically comprising more than 50 hairs. Other body hairs were spared and were in normal in thickness. A trichogram revealed 90% of the hairs in anagen phase with dystrophic follicles. Within 2 days, most of the hair on her scalp had fallen out, and she became totally bald []. She also had developed greyish discoloration of the fingernails on 4th hospital day.\nHer complete blood count, metabolic profile, thyroid function tests, vitamin B12, folic acid, ferritin, serum iron, and hormone profile were within normal limits. Eventually, a more detailed anamnesis revealed the source of the patient's alopecia. She stated that she worked with a colleague who was suffering from breast cancer, and she learned from several websites that selenium could aid in cancer prevention. She then purchased 2 kg of paradise nuts online, and consumed 10-15 nuts per day for 20 days with the intention of preventing cancer.\nThe nuts were identified and compared with the existing specimen in the botany herbarium and found to be Lecythis ollaria. As paradise nuts are rich in selenium, a causal relationship was considered between her recent nutritional supplement and the clinical presentation. The patient's plasma level of selenium was found to be 512 mg/L (normal: 74-139 mg/L). She improved with symptomatic treatment. At follow-up after 2 months, her hair started to regrow.