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| LETTER TO THE EDITOR |
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| Year : 2020 | Volume
: 11
| Issue : 1 | Page : 51-53 |
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Hypokalemic paralysis due to primary sjögren syndrome: Literature review
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Department of Neurology; Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
| Date of Submission | 17-Oct-2019 |
| Date of Acceptance | 26-Dec-2020 |
| Date of Web Publication | 12-Feb-2020 |
Correspondence Address:
Mr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul
Brazil
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/INJMS.INJMS_135_19
How to cite this article:
Rissardo JP, Caprara AL. Hypokalemic paralysis due to primary sjögren syndrome: Literature review. Indian J Med Spec 2020;11:51-3 |
How to cite this URL:
Rissardo JP, Caprara AL. Hypokalemic paralysis due to primary sjögren syndrome: Literature review. Indian J Med Spec [serial online] 2020 [cited 2023 Jun 10];11:51-3. Available from: http://www.ijms.in/text.asp?2020/11/1/51/278088 |
Dear Editor,
We read an article in “Indian Journal of Medical Specialities” with great interest. Singh et al., in 2019, reported a case of an adult female who presented with acute quadriplegia and respiratory distress. A diagnosis of renal tubular acidosis (RTA) type 1 (distal) was made. On further tests, antiSjögren's syndrome (SS)-A/Ro and antiSS-B/La were strongly positive. A diagnosis of SS with hypokalemia due to RTA and demyelinating pure motor axonal polyneuropathy was made. After 3 months, the patient returned with complaints of progressive weakness of limbs and breathing difficulty. Thus, she was diagnosed with Guillain–Barré syndrome.[1]
Hypokalemic paralysis due to primary SS was rarely reported in literature. We identified 59 individuals, and we added more one unreported case from our institution [Table 1]. A literature search was performed in Embase, Google Scholar, Lilacs, Medline, Scielo, and ScienceDirect, on a set of terms that included hypokalemic paralysis, SS, and RTA. We included only articles in English or Spanish with a complete report of the treatment.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32] | Table 1: Reports of patients with hypokalemic paralysis due to primary Sjögren syndrome
Click here to view |
We would like to address some important topics extracted from [Table 1]. First, the majority of the individuals were from Asian countries, which accounted for at least one in every three individuals reported. This could be explained by a high prevalence of SS in these countries, even though the rates of autoimmune diseases be the same between the American and Asian populations.[6] Second, it is observed a female prevalence in the studies with this severe complication of SS. In the reports with male, nephrocalcinosis was more frequent, but worse follow-up was markedly noted with females.[9]
Three possible pathophysiological mechanisms were already described to explain the occurrence of hypokalemic paralysis due to primary SS. In this context, an assumption based on antibodies to H+-ATPase and carbonic anhydrase leading to a urine pH >5.5 and a positive urinary anion gap was proposed.[15] The second hypothesis could be a defective kinase related to a component of the regulator of the ATPase.[24] However, these were only observed in a portion of the reported cases.[21] Another possible explanation is the antibodies anti-SSA/Ro, leading to a direct distal RTA.[9]
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
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| 19. | Palkar AV, Pillai S, Rajadhyaksha GC. Hypokalemic quadriparesis in Sjogren syndrome. Indian J Nephrol 2011;21:191-3. [ PUBMED] [Full text] |
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| 21. | Rajagopala S, Danigeti G, Subrahmanyan D. An unusually dry story. Indian J Crit Care Med 2015;19:550-3. [ PUBMED] [Full text] |
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| 23. | Sarah S, Lijo G, Sukanya E, Rajasekaran D. Renal tubular acidosis due to Sjogren's syndrome presenting as hypokalemic quadriparesis: A report of two cases. Indian J Nephrol 2015;25:386-7. [ PUBMED] [Full text] |
| 24. | Seirafian S, Shafie M, Abedini A, Pakzad B, Roomizadeh P. Recurrent attacks of hypokalemic quadriparesis: An unusual presentation of primary Sjögren syndrome. Intern Med 2016;55:1797-800. |
| 25. | Sengul E, Bunul F, Yazici A, Sengul A, Dindar S, Halhalli GS, et al. An unusual initial presentation of Sjögren's syndrome: Severe hypokalemic paralysis secondary to distal renal tubular acidosis. Eurasian J Med 2013;45:218-21. |
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[Table 1]
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