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Transverse leukonychia in severe hypocalcemia
Caterina Foti1, Nicoletta Cassano, Vincenzo O Palmieri
1Unit of Dermatology, Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari, Italy. c.foti@dermatologia.uniba.it
European Journal of Dermatology : EJD
|February 18, 2004
Summary
This study details a young man experiencing muscle cramps and acral tetany due to hypocalcemia, linked to hypoparathyroidism and celiac disease. Nail changes observed were resolved with calcium and calcitriol treatment.
Area of Science:
- Endocrinology
- Gastroenterology
- Dermatology
Background:
- Hypocalcemia, often caused by hypoparathyroidism, can manifest with neuromuscular symptoms like tetany and cramps.
- Celiac disease is an autoimmune disorder that can sometimes be associated with endocrine and metabolic complications.
- Nail changes, though less common, can be indicative of underlying systemic conditions.
Observation:
- A 26-year-old male presented with acral tetany and upper limb muscular cramps.
- Laboratory tests confirmed hypocalcemia, attributed to co-existing hypoparathyroidism and celiac disease.
- Physical examination revealed transverse leukonychia (white discoloration of nails).
Findings:
- Treatment with calcium supplements (calcium lactogluconate, calcium carbonate) and calcitriol effectively resolved the hypocalcemia and associated symptoms.
- The transverse leukonychia also resolved following treatment, suggesting a direct link to calcium levels.
- Hypocalcemia-induced nail alterations may result from a dual mechanism involving angiospasm and disruption of keratin and integrin structures.
Implications:
- This case highlights the importance of considering endocrine and gastrointestinal causes in patients presenting with unexplained hypocalcemia and neuromuscular symptoms.
- Recognizing nail changes like transverse leukonychia can serve as a clinical clue for diagnosing underlying hypocalcemia.
- Effective management of hypocalcemia with calcium and vitamin D analogs can reverse associated dermatological manifestations, improving patient outcomes.