Earliest Manifestation of Idiopathic Hypoparathyroidism Presenting as Fahr Syndrome with Chronic Hypocalcaemia: A Rare Case Report from Saudi Arabia

Fahr’s syndrome is a rare neurological condition characterized by symmetrical intracranial calcifications. We report a case of 43-year-old Saudi female with a known history of epilepsy who presented with fever, recurrent tonicclonic seizures, and a productive cough. Initial investigations revealed severe hypocalcemia, hypomagnesemia, and hypokalemia, alongside low parathyroid hormone levels. Imaging studies, including CT confirmed symmetrical calcifications in the basal ganglia, thalami, dentate nuclei, and corona radiata, consistent with Fahr’s syndrome. The patient was diagnosed with Fahr’s syndrome secondary to idiopathic primary hypoparathyroidism. There is no specific treatment is currently available, therefore, the patient treated with intravenous calcium gluconate, magnesium, potassium replacements, vitamin D supplementation, and antibiotics for aspiration pneumonia. Neuropsychiatric symptoms and seizures improved following electrolyte normalization, and she was discharged on maintenance therapy. This case highlights the importance of recognizing systemic manifestations of electrolyte imbalances, particularly in rare disorders like Fahr’s syndrome, to enable prompt diagnosis and appropriate management