The Impact of COVID-19 Infection on a Neurologically Compromised Male With Fahr’s Disease Presenting With Acute Delirium and Aspiration Pneumonia: A Case Report

Abstract

Fahr’s disease or idiopathic basal ganglia calcification is a rare, sporadic, genetically dominant, and inherited neurological condition that manifests with dysphagia and Parkinson’s disease. The computed tomography (CT) scan is the method of choice to diagnose basal ganglia calcifications seen in Fahr’s disease. This case report elaborates on the emergency management of a 58-year-old male patient with acute respiratory distress, acute delirium, schizophrenia, Fahr’s syndrome, and history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 or COVID-19) infection. The patient’s chest X-ray, laboratory workup, and vital signs were suggestive of aspiration pneumonia-induced sepsis and acute hypoxemic respiratory failure. Post-admission antibiotic management reduced sepsis complications without improving the altered mental status. A comprehensive clinical assessment suggested the attribution of Fahr’s disease to the patient’s aspiration pneumonia and other clinical complications. In addition, COVID-19 infection, sepsis-induced inflammatory processes, and pre-existing neurological compromise possibly deteriorated the patient’s neurological outcomes, overall prognosis, and recovery.

Fahr’s Syndrome for Primary Hypoparathyroidism in a Patient With COVID-19

“…In our case, the diagnosis was made by the presence of seizures and laboratory data suggestive of Fahr's syndrome. With this third case, it is evident that the systemic inflammatory response produced by COVID-19 can, in some cases, exacerbate the metabolic alterations that cause Fahr's syndrome and have complications in the evolution of patients [15,16] The general mortality rate for COVID-19 infection was described as less than 3.6%, adults over 60 years old, patients with a high SOFA score, and patients with several comorbidities, such as our patient, have higher probabilities of developing severe disease associated with higher mortality. Until now, no evidence confirms that patients with COVID-19 and hypoparathyroidism are at risk for higher complications, even though it has been proposed that lower serum calcium levels at presentation may correlate with severe COVID-19 disease [17][18][19][20].…”

“…In our case, the diagnosis was made by the presence of seizures and laboratory data suggestive of Fahr's syndrome. With this third case, it is evident that the systemic inflammatory response produced by COVID-19 can, in some cases, exacerbate the metabolic alterations that cause Fahr's syndrome and have complications in the evolution of patients [ 15 , 16 ]…”