Recurrent Hypokalemic Periodic Paralysis Unmasks Sjogren Syndrome without Sicca Symptoms.
Hypokalemic Periodic Paralysis (HPP) may occur as a rare complication of Sjogren Syndrome (SS) and Renal Tubular Acidosis (RTA). A 64-year male patient came with HPP, and was later diagnosed with distal RTA. The patient, who had no xerostomia and xerophthalmia, was diagnosed with primary SS from serologic and histologic findings of minor salivary gland biopsy. The patient recovered after potassium replacement therapy. Renal biopsy was also performed and revealed evidence of tubulointerstitial nephritis. Corticosteroids were administered and there was no recurrence of HPP during a 4-year follow-up period. The case highlights the significance of acute hypokalemia management in emergency department as it can unmask SS even if the SS is not associated with sicca symptoms. Hypokalemic paralysis associated with normal anion gap metabolic acidosis should prompt toward the diagnosis of SS.
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. / School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yao-Min
YM
Hung
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. / School of Medicine, National Yang-Ming University, Taipei, Taiwan. / Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan.
Neng-Chyan
NC
Huang
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. / School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Shue-Ren
SR
Wann
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. / School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yun-Te
YT
Chang
Department of Pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. / School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Jyh-Seng
JS
Wang
D000141:Acidosis, Renal Tubular / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000150:complications / Q000473:pathology; D011188:Potassium / Q000008:administration & dosage; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D003520:Cyclophosphamide; D011188:Potassium; D008775:Methylprednisolone