Acute bilateral vision and hearing loss following high-dose selenium ingestion: a case report

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Abstract
Background: Selenium is an essential trace element widely used in health supplements. Reported cases of selenium poisoning have mainly involved hair loss, nail changes, and liver dysfunction, whereas toxic encephalopathy is uncommon. To date, no cases of selenium poisoning causing vision or hearing loss have been reported. Case Presentation: We report a 27-year-old woman employed in health supplement research and development who was occupationally exposed to multiple selenium compounds. During product testing in April 2025, she ingested selenium-containing samples. Based on the product formulation and the recorded amount sampled, the estimated oral selenium intake was 40.146 mg; however, this value represents an exposure estimate rather than a directly measured absorbed dose. She subsequently developed multisystem toxicity, including toxic encephalopathy, bilateral vision loss, hearing loss, liver dysfunction, alopecia, nail changes, and radial bone marrow edema. Initial symptoms were nausea and vomiting, followed by hearing loss, impaired consciousness, vision loss, and liver dysfunction. The first post-exposure blood selenium concentration was 13,131.8 ng/mL, and the urinary selenium concentration was 20,756.1 ng/mL. Intervention and Outcome: Treatment included sedation, diuretics, corticosteroids, hyperbaric oxygen therapy, organ protection, neurotrophic support, anti-infective therapy, and nutritional support. Consciousness recovered within 2 weeks, and liver function normalized. Vision transiently improved but later worsened. At 35-week follow-up, the right eye had no light perception, the left eye had visual acuity of 20 cm, and hearing loss had progressed to complete deafness. Conclusion: Extremely high-dose selenium ingestion can cause toxic encephalopathy and previously unreported persistent vision and hearing loss. Early supportive treatment and measures promoting selenium elimination may improve some clinical outcomes.

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