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

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.