A 61‐year‐old white man with a history of hypoparathyroidism, recently diagnosed ventricular septal defect, right aortic arch, atrial fibrillation, personality disorder, and seizure due to hypocalcemia presented to us with confusion, irritability, and lethargy. He denied any focal neurological deficit, tingling and numbness, speech abnormality or drooping of face. His symptoms were initially confused with stroke, however his brain MRI was negative. When he was first diagnosed with seizure due to hypocalcemia 6 years ago he was started on calcium and has been on it since then. Formal evaluation for his low calcium was also done in the past which revealed low PTH. Vitamin D and magnesium were normal. He denied parathyroid surgery, symptoms of malabsorption, family history of calcium disorder and diuretic intake. On further lab testing it was found that calcium was 6.5 mg/dL, magnesium 1.9 mg/dL, phosphorous 5.7 mg/dL, albumin 3.2 g/dL, ionized calcium 0.90 mg/dL, and corrected calcium of 7.3 mg/dL. MRI of the brain was normal. His cardiac anomaly, low calcium, and low PTH level prompted us to do genetic analysis for Di George syndrome (DGS), which was positive. Immunological test showed CD3+ T cells of 454/mm3. Our patient had multiple admissions with neurological complaints which were attributed to low calcium level. He also had atrial fibrillation that was not well controlled most likely due to hypocalcemia.
Diagnosis of DGS requires reduced number of CD3+ T cells, along with either demonstrated deletion in the chromosome 22q11.2 or typical clinical findings. Management of DGS requires multidisciplinary approach. Sinopulmonary infections are common and aggressive antibiotic therapy is instituted early. Hypocalcemia is treated with calcium supplementation after the measurement of serum calcium and PTH level. Involvement of psychiatrist is required for the proper treatment of schizophrenia and major depression.
Although uncommon to be presenting in the elderly population, recognition of Di George syndrome in the setting of repeated neurological symptoms and hypocalcemia is important. Treatment is based on multidisciplinary approach.
To cite this abstract:Aryal M. Repeated Episodes of Neurological Symptoms and Severe Hypocalcemia, Thinking Beyond the Usual Causes. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 446. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/repeated-episodes-of-neurological-symptoms-and-severe-hypocalcemia-thinking-beyond-the-usual-causes/. Accessed May 22, 2019.