Sjogren's syndrome presenting with hypokalemic paralysis

Ben Hassen,Ouali Jhen

doi:10.5348/crint-2015-12-cr-7

Abstract

Introduction: Acute systemic weakness is a common reason for emergency department visit. Acute hypokalemic paralysis is one of its clinical presentation forms. It is a rare but treatable cause of acute weakness. We report a case that presented with hypokalemic paralysis in emergency room. Case Report: We report a rare case of a 36-year-old female presented with sudden onset flaccid left hemiparesis with no significant past clinical history. Initially the patient was considered as an ischemic stroke, but she was later found to have hypokalemia due to distal renal tubular acidosis and further diagnosed as case of Sjögren's syndrome. Conclusion: Acute flaccid neuromuscular weakness is a common presenting symptom in emergency room. Hypokalemia is an important differential diagnosis. The cause of hypokalemia should be sought. The diagnosis of distal renal tubular acidosis must be considered in patients presenting with hypokalemic paralysis and renal stones, and may be the first clue in the identification of an underlying autoimmune disorder, particularly Sjögren's syndrome.

Highlights

Acute systemic weakness is a common reason for emergency department visit
Among its clinical presentation forms, we find the acute hypokalemic paralysis, which characterized by acute systemic weakness and low serum potassium
We report a case that presented with hypokalemic paralysis in emergency room

Summary

Introduction

Acute systemic weakness is a common reason for emergency department visit The etiologies of this syndrome are very diverse including neurologic, metabolic, and infectious causes. Anti dsDNA, anti-Sm, anti-SSB, anti-SCL70 and anti-JO1 antibodies, rheumatoid factor and CIC were negative These reports and distal RTA raised a high index of suspicion of Sjögren’s syndrome. Patient received a potassium supplementation at the dose of 1 g per hour and alkalinization by sodium bicarbonate at the dose of 100 mEq in the emergency department. She was treated by prednisolone at the dose of 0.5mg/kg/day for six weeks with good outcome.

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CONCLUSION