Transient hypoparathyroidism masquerading as Guillain-Barré syndrome in a 7-year-old child

Kanimozhy Ravicoumar; Dhyalini Raj; Thumjaa Annamalai

doi:10.18203/2349-3291.ijcp20252612

Authors

Kanimozhy Ravicoumar Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Indira Gandhi Medical College and Research Institute, Puducherry, India
Dhyalini Raj Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Indira Gandhi Medical College and Research Institute, Puducherry, India
Thumjaa Annamalai Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Indira Gandhi Medical College and Research Institute, Puducherry, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20252612

Keywords:

Immune-mediated polyradiculoneuropathy, Hypocalcemia, Hyperphosphatemia

Abstract

Primary hypoparathyroidism may manifest in ill children or as a result of autoantibodies targeting the parathyroid glands. Guillain-Barré syndrome (GBS) is a prevalent worldwide condition that is a post-infectious, monophasic, immune-mediated polyradiculoneuropathy. Transient hypoparathyroidism, which necessitates short-term treatment, can occur in neuroinflammatory diseases like GBS. Here we report a seven-year-old girl experienced an ascending and symmetrical weakness, severe pain, muscle cramps, tingling sensations, and paresthesias in both lower limbs for one day. She struggled with micturition and defecation. Despite this, she had intact higher mental functions, hypotonia of both lower limbs, power (2/5), brisk lower limb reflexes, extensor plantar response, and tenderness in both calf muscles. A diagnosis of Guillain-Barré syndrome (GBS) was made due to ascending progressive weakness, and intravenous immunoglobulin was initiated at 2 g/kg. Due to severe muscle cramps, tingling, and distal paresthesias, further workup revealed hypocalcemia, hyperphosphatemia, low parathormone, and low 25(OH)D levels. After starting oral elemental calcium and vitamin D supplements, the child improved symptomatically in the second week. This case report emphasis the need for identification of transient primary hypoparathyroidism, sharing similar clinical characteristics with GBS, which could be overlooked and if not addressed, may result in seizures or cardiac arrhythmias.

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References

Yuki N, Kokubun N, Kuwabara S, Sekiguchi Y, Ito M, Odaka M, et al. Guillain-Barré syndrome associated with normal or exaggerated tendon reflexes. J Neurol. 2012;259(6):1181–90.

Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain–Barré syndrome in low-income and middle-income countries: challenges and prospects. Nature Rev Neurol. 2021;17(5):285-96. DOI: https://doi.org/10.1038/s41582-021-00467-y

Pasieka JL, Wentworth K, Yeo CT, Cremers S, Dempster D, Fukumoto S, et al. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res Off J Am Soc Bone Miner Res. 2022;37(12):2586–601. DOI: https://doi.org/10.1002/jbmr.4714

Korkmaz HA, Ozkan B. Hypoparathyroidism in children and adolescents. Ann Pediatr Endocrinol Metab. 2023;28(3):159–67. DOI: https://doi.org/10.6065/apem.2346096.048

Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671–83. DOI: https://doi.org/10.1038/s41582-019-0250-9

Elendu C, Osamuyi EI, Afolayan IA, Opara NC, Chinedu-Anunaso NA, Okoro CB, et al. Clinical presentation and symptomatology of Guillain-Barré syndrome: A literature review. Med (Baltimore). 2024;103(30):38890. DOI: https://doi.org/10.1097/MD.0000000000038890

Yuki N, Kokubun N, Kuwabara S, Sekiguchi Y, Ito M, Odaka M, et al. Guillain-Barré syndrome associated with normal or exaggerated tendon reflexes. J Neurol. 2012;259(6):1181–90. DOI: https://doi.org/10.1007/s00415-011-6330-4

Liu S, Dong C, Ubogu EE. Immunotherapy of guillain-barre syndrome. Human vacc Immunotherap. 2018;14(11):2568-79. DOI: https://doi.org/10.1080/21645515.2018.1493415

Zaidi SS, Siddiqui T, Siddiqui SJ. Acute Onset of Quadriplegia Secondary to Hypoparathyroidism: Mimicker of AMAN Variant of GBS. J Coll Physicians Surg--Pak. 2018;28(3):23–5. DOI: https://doi.org/10.29271/jcpsp.2018.03.S23

Gay JD, Grimes JD. Idiopathic hypoparathyroidism with impaired vitamin B12 absorption and neuropathy. Can Med Assoc J. 1972;107:54-6.

Gomez MR, Engel AG, Dyck PJ. Progressive ataxia, retinaldegeneration, neuromyopathy, and mental subnormality in apatient with true hypoparathyroidism, dwarfism, mal absorption and cholelithiasis. Neurol. 1972;22:849-55. DOI: https://doi.org/10.1212/WNL.22.8.849

Dionisi-Vici C, Garavaglia B, Burlina AB, Bertini E, Saponara I, Sabetta G, et al. Hypoparathyroidism in mitochondrial trifunctional protein deficiency. J Pediatr. 1996;129:159-62. DOI: https://doi.org/10.1016/S0022-3476(96)70206-8

Goswami R, Bhatia M, Goyal R, Kochupillai N. Reversible peripheral neuropathy in idiopathic hypoparathyroidism. Acta Neurol Scand 2002;105:128-31. DOI: https://doi.org/10.1034/j.1600-0404.2002.1c031.x

Shield KD, Parry C, Rehm J. Chronic diseases and conditions related to alcohol use. Alcohol Res Curr Rev. 2014;35(2):155.

Ghosh K, Bhattacharya A, Sengupta N. Pandora’s box: Neurological manifestations of hypoparathyroidism. Indian J Endocrinol Metabol. 2017;21(4):638. DOI: https://doi.org/10.4103/ijem.IJEM_44_17