PMC9428647_01
The patient's initial ECG shows prolonged QT interval and inverted T waves in all leads except V1.
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ECG analysis revealed prolonged QT interval - QTC 657 ms (normal: 350-440 ms) and inverted T wave in all leads (Figure 1).
Patient brain CT scan. A, B - transverse plane images; C - coronal plane image. White arrows show intracerebral calcifications.
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Brain computed tomography (CT) scan showed hyperdense zones bilaterally in basal ganglia, periventricular region, and white matter (Figure 2). Due to the remaining mental status deficit and clinically ineffective treatment, the patient's brain CT scan was revalued, and Fahr's syndrome - calcifications in corona radiata and basal ganglia were identified (Figure 2).
Patient's hands. Dry skin and onycholysis can be seen.
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Moreover, careful skin and appendages examination revealed dry, yellowish hand and body skin, hyperpigmented palm lines, and onycholysis (Figure 3).
Patient's ECG after electrolytes correction showing returned to normal QT interval and remained T wave inversion in V2-V4 leads.
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RR 16 breath/min, and saturation of 98% on room air. Repeated ECG showed a return to normal QT interval, while T wave remained inverted in V2-V4 leads (Figure 4).
Total and ionized calcium concentration changes during patient hospitalization. Empty parts represent hospitalization days when a test was not performed. The dashed line shows the introduction of intravenous calcium gluconate, oral calcium carbonate, and vitamin D supplementation.
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Patients' magnesium, calcium, and phosphate concentrations were monitored and kept relatively stable with the prescribed treatment for 15 days while at the hospital (Figure 5 and 6).
Magnesium and phosphorus concentration changes during patient hospitalization. Empty parts represent hospitalization days when a test was not performed. The dashed line shows the introduction of intravenous magnesium supplementation.
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Patients' magnesium, calcium, and phosphate concentrations were monitored and kept relatively stable with the prescribed treatment for 15 days while at the hospital (Figure 5 and 6).