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Received Mar 29, 2017; Revised Jun 14, 2017; Accepted Jul 2, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Sjögren’s syndrome is an autoimmune disease with glandular (salivary and lacrimal) and extraglandular (neurologic, renal, hepatic, respiratory, vascular, and cutaneous) manifestations. Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sjögren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others [1], of which RTA is the main clinical presentation [2]. RTA has been reported in 4.3 to 9% of pSS patients; it is more common in middle-aged women, and two-thirds of them will develop symptoms [2, 3]. Hypokalemic paralysis is the initial symptom in seven percent of patients with Sjögren’s syndrome [4]. We present a case of paralysis due to RTA in a pSS patient and also discuss the treatment in these patients.
2. Case Report
A 31-year-old female presented to the emergency room due to a 3-day history of progressive weakness and pain of the upper and lower extremities until walking was impossible. Two days before admission, cramps and generalized dysesthesias were evidenced. On admission, the patient presented mild dyspnea. Her past medical record was significant for polyarthralgias in carpal, metacarpophalangeal, and proximal interphalangeal joints and dry mouth for the past three months. She denied use of alcohol, illicit drugs, or herbal medicines. Her vital signs on admission were a temperature of 36.3°C, a heart rate of 54 beats per minute, a respiratory rate of 20 breaths per minute, oxygen saturation of 97% at room air, capillary blood glucose of 103 g/dL, and blood pressure of 100/60 mmHg. On physical examination, the deep tendon reflexes were globally diminished, her muscle strength, both proximal and distal, was 3/5 on Lovett’s scale, and her tongue was dry and the infralingual salivary pooling was...