{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:27:15Z","timestamp":1792794435215,"version":"4.5.0"},"reference-count":22,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,2,15]]},"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>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\u2019s syndrome type 5. The patient\u2019s 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.<\/jats:p>","DOI":"10.1136\/bcr-2022-253752","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T09:40:38Z","timestamp":1678268438000},"page":"e253752","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-108X","authenticated-orcid":false,"given":"Tushar Ashok","family":"Vidhale","sequence":"first","affiliation":[{"name":"General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7958-2864","authenticated-orcid":false,"given":"Rucha Prafulla","family":"Bhalde","sequence":"additional","affiliation":[{"name":"Radiology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minal","family":"Pande","sequence":"additional","affiliation":[{"name":"General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shital Pradeep","family":"Mahure","sequence":"additional","affiliation":[{"name":"Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"2025082800344183000_16.3.e253752.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0803050"},{"key":"2025082800344183000_16.3.e253752.2","doi-asserted-by":"crossref","first-page":"17055","DOI":"10.1038\/nrdp.2017.55","article-title":"Hypoparathyroidism","volume":"3","author":"Mannstadt","year":"2017","journal-title":"Nat Rev Dis Primer"},{"key":"2025082800344183000_16.3.e253752.3","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1210\/jc.2015-3908","article-title":"Epidemiology and diagnosis of hypoparathyroidism","volume":"101","author":"Clarke","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"2025082800344183000_16.3.e253752.4","doi-asserted-by":"crossref","unstructured":"Roszko KL , Stapleton Smith LM , Sridhar AV , et al . Autosomal dominant hypocalcemia type 1: A systematic review. J Bone Miner Res Off J Am Soc Bone Miner Res 2022. doi:10.1002\/jbmr.4659","DOI":"10.1002\/jbmr.4659"},{"key":"2025082800344183000_16.3.e253752.5","doi-asserted-by":"crossref","unstructured":"Brandi ML , Brown EM . Clinical presentation of hypoparathyroidism. In: Brandi ML , Brown EM , eds. Hypoparathyroidism. Milano: Springer Milan, 2015: 155\u201365.","DOI":"10.1007\/978-88-470-5376-2"},{"key":"2025082800344183000_16.3.e253752.6","doi-asserted-by":"crossref","unstructured":"Rosen CJ . Hypoparathyroidism and pseudohypoparathyroidism. In: Rosen CJ , ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. Ames, USA: John Wiley & Sons, Inc, 2013: 579\u201389.","DOI":"10.1002\/9781118453926.ch72"},{"key":"2025082800344183000_16.3.e253752.7","doi-asserted-by":"crossref","first-page":"148","DOI":"10.3345\/kjp.2015.58.4.148","article-title":"Autosomal dominant hypocalcemia with Bartter syndrome due to a novel activating mutation of calcium sensing receptor, Y829C","volume":"58","author":"Choi","year":"2015","journal-title":"Korean J Pediatr"},{"key":"2025082800344183000_16.3.e253752.8","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.amjmed.2003.06.009","article-title":"How stressful can it be to catch a thief? the influence of stress on calcium metabolism","volume":"116","author":"de Beukelaar","year":"2004","journal-title":"Am J Med"},{"key":"2025082800344183000_16.3.e253752.9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1530\/EJE-19-0558","article-title":"Long acting porcine sequence ACTH in the diagnosis of adrenal insufficiency","volume":"181","author":"Nair","year":"2019","journal-title":"Eur J Endocrinol"},{"key":"2025082800344183000_16.3.e253752.10","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.1212\/WNL.0000000000003102","article-title":"Clinical Reasoning: a 57-year-old man with subacute gait difficulty and hand tremor","volume":"87","author":"Paliwal","year":"2016","journal-title":"Neurology"},{"key":"2025082800344183000_16.3.e253752.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f2213","article-title":"Investigating hypocalcaemia","volume":"346","author":"Hannan","year":"2013","journal-title":"BMJ"},{"key":"2025082800344183000_16.3.e253752.12","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1056\/NEJMcp1800213","article-title":"Hypoparathyroidism","volume":"380","author":"Solomon","year":"2019","journal-title":"N Engl J Med"},{"key":"2025082800344183000_16.3.e253752.13","article-title":"Review of hypoparathyroidism","volume":"7","author":"Abate","year":"2016","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025082800344183000_16.3.e253752.14","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvaa190","article-title":"Autosomal dominant hypocalcemia with atypical urine findings accompanied by novel CaSR gene mutation and vitd deficiency","volume":"5","author":"Tsuji","year":"2021","journal-title":"J Endocr Soc"},{"key":"2025082800344183000_16.3.e253752.15","doi-asserted-by":"publisher","DOI":"10.1136\/adc.54.3.236"},{"key":"2025082800344183000_16.3.e253752.16","doi-asserted-by":"crossref","first-page":"489","DOI":"10.4103\/2230-8210.95763","article-title":"Do we need sick-day guidelines for hypoparathyroidism?","volume":"16","author":"Bhadada","year":"2012","journal-title":"Indian J Endocrinol Metab"},{"key":"2025082800344183000_16.3.e253752.17","doi-asserted-by":"publisher","DOI":"10.1530\/EC-17-0234"},{"key":"2025082800344183000_16.3.e253752.18","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4103\/0971-4065.132018","article-title":"An interesting case of primary hypoparathyroidism","volume":"24","author":"Kirpalani","year":"2014","journal-title":"Indian J Nephrol"},{"key":"2025082800344183000_16.3.e253752.19","doi-asserted-by":"crossref","first-page":"106514","DOI":"10.1016\/j.clineuro.2021.106514","article-title":"Fahr\u2019s syndrome due to hypoparathyroidism revisited: a case of parkinsonism and a review of all published cases","volume":"202","author":"Kalampokini","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"key":"2025082800344183000_16.3.e253752.20","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.2001.81.1.239"},{"key":"2025082800344183000_16.3.e253752.21","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfv081"},{"key":"2025082800344183000_16.3.e253752.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09842-2"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-253752","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:34:48Z","timestamp":1756366488000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-253752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,2]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/bcr-2022-253752"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-253752","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}