Recurrent tetany in a male patient with short bowel syndrome and Crohn’s disease

In the course of Crohn’s disease (CD), several clinical symptoms may occur, primarily associated with gastrointestinal problems. However, CD may also cause other important health disturbances, such as atypical metabolic disturbances or electrolyte imbalance.
A 48-year-old male with CD (diagnosed September 2022) and reactive arthritis was admitted to the Internal Medicine Department. The patient had a history of surgically treated gastric ulcer perforation complicated by diffuse peritonitis, peritoneal adhesions, and iatrogenic small intestine perforation, which required ileostomy formation (August 2022).
In October 2022 the patient was admitted because of tetany with motor aphasia, binocular diplopia, weakness of the lower extremities, and with tongue and upper limb stiffening. Additionally, the patient reported pain located in the left elbow joint and the left knee joint.
On admission, a physical examination revealed a postoperative surgical wound in the middle epigastrium, with small amounts of serous and cloudy liquid and ileostomy in the right middle abdomen.
A preliminary diagnosis initially indicated stroke as a possible cause of the symptoms; however, computed tomography (CT) of the head excluded this. CT enterography revealed inflammatory lesions in the small and large intestine distal to the stoma, with the presence of adhesions and interloop fistulas, a small amount of fluid in the abdominal, pelvic, and pleural cavities, hepatosplenomegaly, and enlarged external iliac (18 mm) and left periaortic (15 mm) lymph nodes.
Laboratory blood tests showed severe hypocalcaemia (5.35 mg/dl [reference: 8.6–10.00]), low ionised calcium concentration (0.67 mmol/l [reference: 1.15–1.35]), hypomagnesaemia (0.55 mg/dl [reference: 1.6–2.6]), hyperphosphataemia (5.17 mg/dl [reference: 2.5–4.5]), hypoproteinaemia (5.52 g/dl [reference 6.6–8.3]), hypoalbuminaemia (2.8 g/dl [reference 3.5–5.2]), high C-reactive protein (111 mg/l [reference: < 5.0]), high D-dimers (1772 ng/ml [reference: < 500]), high parathyroid hormone (PTH) (92.48 pg/ml [reference: 15.00–65.00]), low red blood cell count (RBC) (3.08 × 106/µl [reference: 4.2–5.7 × 106/µl]), low haemoglobin (10.4 g/dl [reference: 13.5–16.5]), low folic acid (3.83 ng/ml [reference: 3.89–26.8]), and low 25-hydroxy vitamin D3 (VitD3) (17.00 ng/ml [reference: 30.00–50.00]) concentrations. The kidney function was preserved with creatinine concentration of 0.83 mg/dl [reference: 0.67–1.17] and...


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