Hypokalaemic quadriparesis due to distal renal tubular acidosis unmasking underlying Sjögren's disease.

Abstract

We report the case of a female in her 40s who presented to our emergency department with acute weakness in all limbs for 1 day. Clinical examination alongside point-of-care investigations confirmed acute areflexic flaccid quadriparesis due to severe hypokalaemia. She was found to have distal renal tubular acidosis on further investigation. A detailed clinical history and judicious use of laboratory diagnostic services systematically ruled out idiopathic cause of distal renal tubular acidosis. Neglected sicca symptoms were retrospectively unearthed after a positive Schirmer's test. A diagnosis of Sjögren's disease was considered after initial auto-immune screening. Subsequent definitive serology tested positive for anti-Sjogren's syndrome-associated antigens A (SS-A) and B (SS-B). This case is distinct in that the presenting symptom of Sjögren's disease was acute areflexic quadriparesis. We hope to highlight Sjögren's disease as a likely differential for seemingly idiopathic renal tubular acidosis even in the absence of overt sicca symptoms.