The Diagnostic Journey of Fahr’s Syndrome: A Case Report of Misdiagnosed Multisystem and Neuropsychiatric Symptoms Due to Hypocalcemia Secondary to Hypoparathyroidism

Simultaneous psychiatric and neurological manifestations with multisystem involvement often create diagnostic dilemmas and increase the expenditure of undiagnosed cases. It is crucial to rule out reversible medical pathologies before labeling them as primary psychiatric disorders. We present the case of a 50-year-old female complaining of episodic breathlessness with a provisional diagnosis of asthma by a pulmonologist and later on depressive cognition panic attacks pointed towards the diagnosis of moderate depressive episode with somatic symptoms and panic disorder by a psychiatrist. Despite treatment, there was no improvement and new onset focal seizures leading to generalized tonic-clonic seizures evolved. Neuroimaging revealed bilateral diffuse hyperdense parenchymal calcification and metabolic profile showed hypocalcemia secondary to hypoparathyroidism, confirming the diagnosis of Fahr’s syndrome. She was prescribed antiepileptics to control seizures and supplemented with high doses of calcium, vitamin D and magnesium. She became asymptomatic within a month. Hence, our case highlights the importance of neuroimaging and metabolic profiles in uncovering hidden aetiologies and formulating individualized treatment strategies.