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Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis
  1. Tushar Ashok Vidhale1,
  2. Rucha Prafulla Bhalde2,
  3. Minal Pande1 and
  4. Shital Pradeep Mahure3
  1. 1General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
  2. 2Radiology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
  3. 3Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
  1. Correspondence to Dr Tushar Ashok Vidhale; tusharvidhale{at}


A man in his 20s who had previously experienced multiple episodes of transient loss of consciousness, majorly attributable to the seizures, presented with a 1-month history of increased seizure frequency, high-grade fever and weight loss. Clinically, he had postural instability, bradykinesia and symmetrical cogwheel rigidity. His investigations revealed hypocalcaemia, hyperphosphataemia, inappropriately normal intact parathyroid hormone, metabolic alkalosis, normomagnesemic magnesium depletion, and increased plasma renin activity and serum aldosterone concentration. CT scan of the brain revealed symmetrical calcification of the basal ganglia. The patient had primary hypoparathyroidism (HP). A similar presentation of his brother indicated a genetic cause, most likely autosomal dominant hypocalcaemia with Bartter’s syndrome type 5. The patient’s fever was caused by underlying haemophagocytic lymphohistiocytosis secondary to pulmonary tuberculosis, which triggered acute episodes of hypocalcaemia. This case represents a complex interplay of a multifaceted relationship between primary HP, vitamin D deficiency and an acute stressor.

  • Calcium and bone
  • Fluid electrolyte and acid-base disturbances
  • Vitamins and supplements

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  • Contributors TAV, RPB, MP and SPM were involved in drafting the report and analyse and interpret the data required for the work. TAV designed the concept. All authors critically reviewed the manuscript. All authors have given approval for the publication of the final version of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.