Case Report Dilated Cardiomyopathy Induced by Chronic Starvation and Selenium Deficiency Soham Dasgupta 1 and Ashraf M. Aly 2 1 Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77555, USA 2 Department of Pediatric Cardiology, University of Texas Medical Branch, Galveston, TX 77555, USA Correspondence should be addressed to Ashraf M. Aly; amaly@utmb.edu Received 17 July 2016; Accepted 1 November 2016 Academic Editor: Bibhuti Das Copyright © 2016 S. Dasgupta and A. M. Aly. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Protein energy malnutrition (PEM) has been rarely documented as a cause of cardiovascular abnormalities, including dilated cardiomyopathy. Selenium is responsible for antioxidant defense mechanisms in cardiomyocytes, and its defciency in the setting of PEM and disease related malnutrition (DRM) may lead to exacerbation of the dilated cardiomyopathy. We report a rare case of a fourteen-year-old boy who presented with symptoms of congestive heart failure due to DRM and PEM (secondary to chronic starvation) along with severe selenium defciency. An initial echocardiogram showed severely depressed systolic function consistent with dilated cardiomyopathy. Aggressive nutritional support and replacement of selenium and congestive heart failure medications that included diuretics and ACE inhibitors with the addition of carvedilol led to normalization of the cardiac function within four weeks. He continues to have signifcant weight gain and is currently completely asymptomatic from a cardiovascular standpoint. 1. Introduction Te World Health Organization (WHO) defnes malnutrition as “the cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specifc functions [1].” Te term protein energy malnutrition (PEM) applies to a group of related dis- orders that include marasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor. Marasmus involves inade- quate intake of protein and calories and is characterized by emaciation while kwashiorkor involves normal caloric intake but inadequate protein intake. We report a rare case of dilated cardiomyopathy caused by severe malnutrition combined with selenium defciency in a teenager. Te malnutrition seen in this patient can be more accurately defned as “disease or injury related malnutrition” and is commonly seen in the setting of major infection, burns, or trauma [2]. 2. Case Report A fourteen-year-old boy from South America was transferred to the burn unit at our institution for severe malnutrition. Te patient had sustained second-degree burns (>25% BSA) two years prior to admission. He did not receive adequate nutrition and medical care because of poverty and limited resources in his home country. He was noted to be severely cachectic and malnourished at a local hospital and was transferred to the United States by a charity organization for higher level of care. Initial assessment was signifcant for a weight of 19 kg (<3rd percentile on WHO growth chart), height of 141 cm (BMI 9.6 kg/m 2 ,  score −12.42), blood pressure of 92/63 mmHg, and a heart rate of 140 bpm. He experienced shortness of breath with minimal physical activity. Physical examination revealed severe cachexia with atrophy of all muscles without peripheral edema. He was also noted to be moderately dehydrated. Initial investigations were signifcant for mild hyponatremia [133 mmol/L (NL 135– 145 mmol/L)], severe hypoalbuminemia [0.2 g/dL (NL 3.5–5.0 g/dL)], hypocalcemia [ionized calcium 3.2 mg/dL (NL 4.5–5.3 mg/dL)], severe iron defciency anemia [hemoglobin/hematocrit 6.7 gm/dL/24.8%, MCV 69.3 FL], and selenium defciency [32 ug/L]. Te reported normal serum selenium levels in the United States ranges from 50 Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2016, Article ID 8305895, 4 pages http://dx.doi.org/10.1155/2016/8305895