# Severe Hypocalcemia Dependent on Fluconazole in a Newborn With Barakat Syndrome

## TL;DR

A newborn with Barakat syndrome showed improved calcium levels after fluconazole treatment, suggesting a novel link between antifungal therapy and calcium metabolism.

## Contribution

This case is the first to report fluconazole's role in normalizing calcium levels in Barakat syndrome through potential vitamin D metabolism effects.

## Key findings

- Fluconazole treatment led to normalization of severe hypocalcemia in a newborn with Barakat syndrome.
- The patient had a novel de novo GATA3 variant confirmed through genetic testing.
- Antifungal therapy may influence calcium homeostasis via vitamin D metabolism in congenital hypoparathyroidism.

## Abstract

We present a case of a newborn with Barakat syndrome, characterized by congenital hypoparathyroidism, severe hypocalcemia, recurrent urinary tract infections (UTIs), and congenital candidiasis, which is an atypical feature for this syndrome. The patient, born at term, exhibited dysmorphia, hearing loss, and renal dysfunction. Genetic testing revealed a novel, de novo GATA3 variant. Fluconazole, introduced to treat recurrent UTIs and congenital candidiasis, unexpectedly played a crucial role in normalizing calcium levels. This effect may be attributed to fluconazole's influence on the metabolism of vitamin D, potentially enhancing calcium absorption and reabsorption. The normalization of calcium levels in this patient emphasizes the complex interplay between antifungal therapy and calcium homeostasis, particularly in patients with congenital hypoparathyroidism. This case highlights the importance of genetic testing in diagnosing neonatal hypocalcemia and illustrates the potential for fluconazole to impact calcium metabolism in Barakat syndrome. A multidisciplinary approach, including immunological, nephrological, and otolaryngological evaluations, is essential for comprehensive long-term care.