Afebrile Seizures as Initial Symptom of Hypocalcemia Secondary to Hypoparathyroidism

Abstract

Hypocalcemia is rare in childhood and caused, among other conditions, by hypoparathyroidism. DiGeorge syndrome is the most common cause of hypoparathyroidism in childhood. Presentation of a rare cause of hypocalcemia in childhood and the necessity of measuring serum electrolyte levels in patients presenting with afebrile seizures. a 7.5-year-old female child presented with afebrile seizures lasting 5 min with postictal drowsiness. A similar episode 1 month ago is described. On admission, a positive Trousseau sign, papilledema, and long QTc on electrocardiography were detected. Laboratory testing revealed hypocalcemia, increased creatine phosphokinase and phosphate levels, decreased levels of parathormone, with normal thyroid function and normal levels of blood gases. considering the diagnosis of hypoparathyroidism possible, we started on calcium gluconate solution 5% intravenously and calcium carbonate per os. 48 h later, the child transferred to tertiary hospital for further evaluation. The laboratory findings revealed 25-OH Vitamin D deficiency with normal cortisol levels and the absence of autoantibodies. Kidney and brain imaging and also the electroencephalogram were normal. Calcium carbonate, magnesium, and Vitamin D were administered per os. The child discharged from hospital with complete resolution of symptoms. Since then, she is in treatment with calcium carbonate and Vitamin D per os. Hypoparathyroidism is rare in childhood. We underline the necessity of measuring serum electrolyte levels in patients presenting with afebrile seizures.

Keywords: Afebrile seizures; children; hypocalcemia; hypoparathyroidism.

Figure 1

Long QTc on electrocardiography of a 7.5-year-old female child presented with afebrile seizures as initial symptom of hypocalcemia secondary to hypoparathyroidism (QTc 0.53 ms, normal ≤0.44)