Hypokalemic acidosis can complicate a primary Sjögren’s syndrome. The clinical feature is rarely revealed by manifestations due to hypokalemia. We report the case of a 46-year-old woman, admitted to explore a paresthesia and paresis of inferior limbs. The diagnosis of Sjögren’s syndrome was retained since there was the association of xerophthalmia, sialadenitis at the labial biopsy and positive immunological results (anti-SSA and anti-SSB). The absence of another auto-immune or systemic illness allowed us to consider that the Sjögren’s syndrome was primary. The biological explorations revealed a hyperchloremic and hypokalemic acidosis. The treatment was based on corticosteroid and potassium supplementation. The follow-up was marked by a clinical and biological amelioration.
References
[1]
Vitali, C. (2003) Classification Criteria for Sjögren’s Syndrome. Annals of the Rheumatic Diseases, 62, 994-995. http://dx.doi.org/10.1136/ard.62.1.94
[2]
Vitali, C., Bombardieri, S., Jonsson, R., Moutsopoulos, H.M., Alexander, E.L., Carsons, S.E., et al. (2002) Classification Criteria for Sjögren’s Syndrome: A Revised Version of the European Criteria Proposed by the American-European Consensus Group. Annals of the Rheumatic Diseases, 61, 554-558. http://dx.doi.org/10.1136/ard.61.6.554
[3]
Varoquier, C., Salmon, J.-H., Sibilia, J. and Gottenberg, J-E. (2013) Classification Criteria for Sjögren’s Syndrome. Revue du Rhumatisme Monographies, 80, 20-25 http://dx.doi.org/10.1016/j.monrhu.2012.11.001
[4]
Goules, A.V., Tatouli, I.P., Moutsopoulos, H.M. and Tzioufas, A.G. (2013) Clinically Significant Renal Involvement in Primary Sjögren’s Syndrome: Clinical Presentation and Outcome. Arthritis & Rheumatology, 65, 2945-2453.
http://dx.doi.org/10.1002/art.38100
[5]
Matsumura, R., Kondo, Y., Sugiyama, T., Sueishi, M., Koike, T., Takabayashi, K., et al. (1988) Immunohistochemical Identification of Infiltrating Mononuclear Cells in Tubulointerstitial Nephritis Associated with Sjögren’s Syndrome. Clinical Nephrology, 30, 335-340.
[6]
Moutsopoulos, H.M., Balow, J.E., Lawley, T.J., Stahl, N.I., Antonovych, T.T. and Chused, T.M. (1978) Immune Complex Glomerulonephritis in Sicca Syndrome. American Journal of Medicine, 64, 955-960. http://dx.doi.org/10.1016/0002-9343(78)90449-7
[7]
Ren, H., Wang, W.M., Chen, X.N., Zhang, W., Pan, X.-X., Wang, X.-L., et al. (2008) Renal Involvement and Follow-Up of 130 Patients with Primary Sjögren’s Syndrome. The Journal of Rheumatology, 35, 278-284.
[8]
Bossini, N., Savoldi, S., Franceschini, F., Mombelloni, S., Baronio, M., Cavazzana, I., et al. (2001) Clinical and Morphological Features of Kidney Involvement in Primary Sjögren’s Syndrome. Nephrology Dialysis Transplantation, 16, 2328-2336.
http://dx.doi.org/10.1093/ndt/16.12.2328
[9]
Goules, A., Masouridi, S., Tzioufas, A.G., Ioannidis, J.P., Skopouli, F.N. and Moutsopoulos, H.M. (2000) Clinically Significant and Biopsy-Documented Renal Involvement in Primary Sjögren’s Syndrome. Medicine (Baltimore), 79, 241-249. http://dx.doi.org/10.1097/00005792-200007000-00005
[10]
Soy, M., Pamuk, O.N., Gerenli, M. and Celik, Y. (2005) A Primary Sjögren’s Syndrome Patient with Distal Renal Tubular Acidosis, Who Presented with Symptoms of Hypokalemic Periodic Paralysis: Report of a Case Study and Review of the Literature. Rheumatology International, 26, 86-89.
http://dx.doi.org/10.1007/s00296-005-0587-9
[11]
Hattori, N., Hino, M., Ishihara, T., Moridera, K., Ikekubo, K. and Kurahachi, H. (1992) Hypokalemic Paralysis Associated with Distal Renal Tubular Acidosis. Internal Medicine, 31, 662-665.
[12]
Khandelwal, D., Bhattacharya, S., Khadgawat, R., Kaur, S., Tandon, N. and Ammini, A.C. (2012) Hypokalemic Paralysis as a Presenting Manifestation of Primary Sjögren’s Syndrome: A Report of Two Cases. Indian Journal of Endocrinology and Metabolism, 16, 853-855. http://dx.doi.org/10.4103/2230-8210.100684
[13]
Rao, N., John, M., Thomas, N., Rajaratnam, S. and Seshadri, M.S. (2006) Aetiological, Clinical and Metabolic Profile of Hypokalaemic Periodic Paralysis in Adults: A Single-Centre Experience. The National Medical Journal of India, 19, 246-249.
[14]
Morovic-Vergles, J., Galesic, K. and Vergles, D. (2007) Primary Sjogren’s Syndrome Presenting as Hypokalemic Paralysis. Annals of Saudi Medicine, 27, 125-127. http://dx.doi.org/10.4103/0256-4947.51532
[15]
Toy, W.C. and Jasin, H.E. (2008) An Unusual Case of Hypokalemic Paralysis Associated with Primary Sjogren’s Syndrome. The Journal of the Arkansas Medical Society, 104, 286-287.
[16]
Baaj, M., Safi, S., Hassikou, H., Tabache, F., Mouden, K. and Hadri, L. (2010) Hypokalemic Paralysis Revealing Sjögren’s Syndrome Associated with Auto-Immune Thyroiditis. Journal of Nephrology & Therapeutics, 6, 52-56. http://dx.doi.org/10.1016/j.nephro.2009.09.002
