Distal renal tubular acidosis with hypokalemic paralysis as primary presentation of Sjogren's syndrome without sicca symptoms: An unusual case presentation

Sjogren's syndrome is a systemic autoimmune disorder characterized by chronic inflammation of the exocrine glands with extra-glandular manifestations. Renal involvement occurs in 18–67% of cases, with chronic tubulo-interstitial nephritis being the most frequent pathology which can lead to distal renal tubular acidosis characterized by normal anion gap acidosis with hypokalemia and alkaline urinary pH. Hypokalemic periodic paralysis can be primary or secondary to potassium deficiency which can arise from several causes. Primary Sjogren's syndrome is a rare cause which can lead to renal involvement producing distal renal tubular acidosis with hypokalemic paralysis.