Endocrine Abstracts

JOINT823

Introduction: Chronic hypocalcaemia is associated with several dermatological disorders, which may take a variety of symptomatic forms. Our case report illustrates this association.

Case report: A 68 years old women who underwent thyroidectomy 10 years ago, was admitted for aetiological assessment of hyperkeratotic, scaly generalized lesions on an erythematous background evolving for 6 months in a context of altered general condition. The anamnesis reported constipation with frilosity and generalised paresthesias, with no other signs. Clinical examination revealed a fever of 38°C and the dermatological lesions described above, associated with diffuse pachyonychia, with positive schvostek more marked on the right side. The work-up revealed a neutrophil cells increase correlated with a rise in the CRP up to 300 mg/l and the sedimentation rate up to 113 mm/h, associated with severe hypocalcaemia to 54 mg/l. The suspicion of psoriasis was strongly supported on the basis of the above, and confirmed by biopsy. Patient was under levothyroxine with adjustement, associated with intravenous and oral correction of blood calcium levels. Dermatologically, a local emollient treatment was initiated. The course was marked by remarkable clinico-biological improvement.

Discussion: The acute response of the keratinocyte to calcium resembles that of the parathyroid cell. Overall, hypocalcaemia will affect keratocyte differentiation and give rise to a binding defect that can be seen in most desquamative and hyperkeratotic dermatological diseases such as psoriasis and pustulosis. As in our patient’s case, it can lead to new or worsening conditions. However, what characterises the dermatological lesions associated with hypocalcaemia is their remarkable evolution after correction of the triggering or aggravating hypocalcaemia. The majority of studies note the beneficial effect of calcium and vitamin D supplementation in the healing process, even in cases of normocalcaemia.

Bibliography: 1. Sh.S. Ashkevari, A. Maboodi, Acute Generalized Pustular Psoriasis and Idiopathic Hypoparathyroidism in an Adolescent Girl. 2. Rajaa Jabbouri, Psoriasis Pustuleux Généralisé Associé À Une Hypocalcémie Sévère. 3. H.H. Qadim, Studying the Calcium Serum Level in Patients Suffring F