Case Report Hypokalemic Paralysis due to Primary Sjögren Syndrome: Case Report and Review of the Literature A. Garza-Alpirez, A. C. Arana-Guajardo, J. A. Esquivel-Valerio, M. A. Villarreal-Alarcón, and D. A. Galarza-Delgado Servicio de Reumatolog´ ıa, Departamento de Medicina Interna, Hospital Universitario “Dr. Jos´ e Eleuterio Gonz´ alez”, Universidad Aut´ onoma de Nuevo Le´ on, Monterrey, NL, Mexico Correspondence should be addressed to A. C. Arana-Guajardo; ana.aranag@gmail.com Received 29 March 2017; Revised 14 June 2017; Accepted 2 July 2017; Published 1 August 2017 Academic Editor: Syuichi Koarada Copyright © 2017 A. Garza-Alpirez et al. Tis 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. Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sj¨ ogren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others. We present a 31-year-old female with hypokalemic paralysis due to distal RTA (dRTA). She received symptomatic treatment and hydroxychloroquine with a good response. Tere is insufcient information on whether to perform a kidney biopsy in these patients or not. Te evidence suggests that there is an infammatory background and therefore a potential serious afection to these patients, such as hypokalemic paralysis. We found 52 cases of hypokalemic paralysis due to dRTA in pSS patients. Te majority of those patients were treated only with symptomatic medication. Patients who received corticosteroids had stable evolution even though they did not have another symptomatology. With such heterogeneous information, prospective studies are needed to assess the value of adding corticosteroids as a standardized treatment of this manifestation. 1. Introduction Sj¨ ogren’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 involve- ment associated with primary Sj¨ ogren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephro- genic 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 Sj¨ ogren’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 signifcant for pol- yarthralgias 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 refexes 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 absent. Remarkable laboratory tests are shown in Table 1. A panoramic photo of minor salivary gland biopsy is shown in Figure 1. With all lab results, a distal RTA (dRTA) diagnosis due to pSS was made. Hypokalemia and metabolic acido- sis were treated with intravenous potassium chloride and Hindawi Case Reports in Rheumatology Volume 2017, Article ID 7509238, 7 pages https://doi.org/10.1155/2017/7509238