A 64-year-old male, with no toxic habits or relevant personal history, presented in the last week a feeling of stiffness in extremities and muscle cramps.
Located to Emergency Department of our Hospital presenting an episode of generalized tonic-clonic movements of several minutes duration.
Physical examination revealed altered level of consciousness, being stupor, and hypertonia of the upper and lower limbs.
Vital signs were normal.
Cardiorespiratory auscultation and abdominal examination showed no abnormalities.
The laboratory tests showed leukocytosis (14.6 K/μL [VN 4.6-10.2 K/μL]) and hypokalemia (2.5 mEq/L [VN 3.5-5 mEq/L]), normal creatinine levels.
The EKG was normal.
Cranial CT and EEG performed urgently showed no abnormalities.
Trousseau and Chvostesk signs were positive.
A new laboratory test confirmed the presence of mild leukocytosis and hypokalemia, and also hypoproteinemia 6.3 g/dL (VN 6.6-8.7 g/dL, hypocalcaemia with total calcium 3.958 mg/dL).
The rest of the parameters, including urea, creatinine, glucose, C-reactive protein and liver biochemistry, were normal.
Clinical and laboratory abnormalities resolved after starting treatment with calcium and magnesium.
Antitransglutaminase and antigliadin antibodies were negative.
Parathyroid hormone levels were elevated (124.5 pg/mL [NV 5-65 pg/mL]) and 25-hydroxyvitamin D3 levels were low (10.1 nmol/l [NV 75-250 nmol]).
Reinterrupting the patient reported several daily soft stools in the last 2-4 years, without abdominal pain or other digestive symptoms.
Pathologic examination, barium radiology of the small intestine and abdominal CAT scan showed abnormalities compatible with CD with extensive involvement of the ileum and inflammatory activity data.
No alterations in duodenum or jejunum were observed.
Corticosteroid treatment was indicated, with normal bowel habits.
Corticodependence was observed, so the patient was treated with azathioprine, with discontinuation of corticosteroids and remaining asymptomatic with normal magnesium and calcium levels.
