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Case Reports
. 2024 May 4;18(1):236.
doi: 10.1186/s13256-024-04563-7.

Unusual presentation of Sjogren's syndrome during pregnancy: a case report

Vijay Sundarsingh  1 , R Manoj Kumar  2 , Manjunath Kulkarni  3 , Firas Rauf Mammoo  4 , Pramela Renisha Rodrigues  2 , Y M Prashanth  4
Affiliations
Case Reports

Unusual presentation of Sjogren's syndrome during pregnancy: a case report

Vijay Sundarsingh et al. J Med Case Rep. .

Abstract

Background: Pregnancy imposes significant physiological changes, including alterations in electrolyte balance and renal function. This is especially important because certain disorders might worsen and make people more susceptible to electrolyte abnormalities. One such condition is Sjogren's syndrome (SS), an autoimmune disease that can cause distal renal tubular acidosis (dRTA). This case report offers a unique perspective on the intricate physiological interplay during pregnancy, emphasizing the critical importance of recognizing and managing electrolyte abnormalities, particularly in the context of autoimmune disorders such as Sjogren's syndrome.

Case presentation: We report a case of a 31-year-old pregnant Indian woman at 24 weeks gestation presenting with fever, gastrointestinal symptoms, and progressive quadriparesis followed by altered sensorium. Severe hypokalaemia and respiratory acidosis necessitated immediate intubation and ventilatory support. Investigations revealed hypokalaemia, normal anion gap metabolic acidosis, and positive autoimmune markers for SS. Concurrently, she tested positive for IgM Leptospira. Management involved aggressive correction of electrolyte imbalances and addressing the underlying SS and leptospirosis.

Conclusion: This case underscores that prompt recognition and management are paramount to prevent life-threatening complications in pregnant patients with autoimmune disease. This report sheds light on the unique challenge of managing hypokalaemic quadriparesis in the context of Sjogren's syndrome during pregnancy.

Keywords: Renal tubular acidosis; Respiratory failure; Severe hypokalaemia; Sjogren’s syndrome (SS).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Day wise potassium and bicarbonate replacements
Fig. 2
Fig. 2
Trend of the serum potassium and muscle power (days 1–5)
Fig. 3
Fig. 3
Timeline of the patient’s clinical course during her stay in hospital
Fig. 4
Fig. 4
Approach to a patient with normal anion gap metabolic acidosis and hypokalemia
See this image and copyright information in PMC

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