Primary hypoparathyroidism may go undiagnosed until a secondary condition, such as dengue, worsens levels of blood calcium, a case report suggests.
The report, “Dengue fever manifesting with tetany as the first presentation of primary hypoparathyroidism: a case report,” was published in the journal BMC Research Notes.
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus and is a major cause of morbidity and mortality in tropical regions. It can manifest as a simple undifferentiated febrile (feverish) illness to a severe clinical syndrome involving fluid leakage, eventually leading to shock.
During infection with the dengue virus, patients have low levels of calcium in their bodies (a condition known as hypocalcemia). However, this is mostly asymptomatic and symptomatic hypocalcemia is a rare occurrence during dengue infection.
A recent case report described a patient who had hypocalcemia during dengue infection and who also was found to suffer from primary hypoparathyroidism — defined by a low concentration of parathyroid hormone (PTH) and low levels of blood calcium.
The patient was a 32-year-old man who came to a hospital in Sri-Lanka with fever, generalized body aches and muscular spasms (tetany). He was of short stature (but with normal upper and lower body proportions) and had undergone bilateral cataract surgery, but was otherwise healthy.
Because of an ongoing epidemic in Sri Lanka, the doctors suspected dengue fever, and preformed an urgent full blood count along with blood calcium levels. The patient was diagnosed with dengue fever and severe hypocalcemia.
Although the individual had never been diagnosed previously, the doctors concluded he had primary hypoparathyroidism.
The patient did not demonstrate any clinical or biochemical features to suggest that his hypoparathyroidism was due to an autoimmune syndrome or underlying genetic disorder. However, genetic analysis for genetic hypoparathyroidism could not be carried out “as facilities for such testing [were] not available in the country at the time of reporting,” the authors wrote.
The infection and acute hypocalcemia were resolved and the patient was placed on calcium supplements to manage his chronic hypoparathyroidism.
“[C]linical features of hypocalcemia may not commonly manifest up to the same degree of severity of hypocalcemia in primary hypoparathyroidism even till late adulthood but potential early clues such as short stature and premature cataract should be actively investigated,” the authors wrote.