A 28-year-old woman living in a selenium-deficient rural belt presents with progressive exertional dyspnoea, cardiomegaly, and biventricular failure. Biopsy shows a multifocal necrotising cardiomyopathy. Her condition improves markedly after supplementation with sodium selenite. This condition corresponds to which named endemic cardiomyopathy?
- A Kashin-Beck disease
- B Keshan disease ✓
- C Takayasu arteritis
- D Chagas cardiomyopathy
Correct answer: B. Keshan disease
Explanation
Keshan disease is an endemic selenium-responsive cardiomyopathy described in selenium-deficient areas of China, thought to involve selenium deficiency acting together with a viral cofactor such as Coxsackie virus. Kashin-Beck disease is the other selenium-related endemic condition but affects joints and epiphyseal cartilage, producing osteoarthropathy rather than heart failure. Takayasu and Chagas have vascular and infective mechanisms respectively.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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