Velarde-Mejía Yelitza, Gamboa-Cárdenas Rocío, Ugarte-Gil Manuel, Asurza César Pastor
Rheumatology Department, Hospital Guillermo Almenara Irigoyen, La Victoria, Peru.
School of Medicine, Universidad Cientifica del Sur, Villa El Salvador, Peru.
Clin Med Insights Arthritis Musculoskelet Disord. 2017 Aug 3;10:1179544117722763. doi: 10.1177/1179544117722763. eCollection 2017.
Acute hypokalemic paralysis is a rare and potentially fatal condition, with few related causes, one of which highlights distal renal tubular acidosis (dRTA). Distal renal tubular acidosis is a rare complication of several autoimmune diseases such as systemic lupus erythematosus, Sjögren's syndrome, and Hashimoto thyroiditis. We report a case of a lupic patient who presented rapidly progressive quadriparesis in the context of active renal disease. Research revealed severe refractory hypokalemia, metabolic acidosis, and alkaline urine suggestive of dRTA. We diagnosed Sjögren's syndrome based on sicca symptoms, an abnormal salivary glands' nuclear scan and the presence of anti-Ro/SSA and anti-La/SSB. In addition, the finding of thyroid peroxidase, thyroglobulin antibodies, and hypothyroidism led us to the diagnosis of Hashimoto thyroiditis. Due to the active renal involvement on the context of systemic lupus erythematosus and Sjögren's syndrome, the patient received immunosuppression with rituximab, resulting in a progressive and complete improvement.
急性低钾性麻痹是一种罕见且可能致命的疾病，相关病因较少，其中之一为远端肾小管酸中毒（dRTA）。远端肾小管酸中毒是系统性红斑狼疮、干燥综合征和桥本甲状腺炎等几种自身免疫性疾病的罕见并发症。我们报告一例狼疮患者，在活动性肾脏疾病背景下出现快速进展性四肢瘫痪。研究发现严重难治性低钾血症、代谢性酸中毒和碱性尿，提示为dRTA。基于干燥症状、唾液腺核扫描异常以及抗Ro/SSA和抗La/SSB的存在，我们诊断为干燥综合征。此外，甲状腺过氧化物酶、甲状腺球蛋白抗体及甲状腺功能减退的发现使我们诊断为桥本甲状腺炎。由于该患者在系统性红斑狼疮和干燥综合征背景下存在活动性肾脏受累，故接受了利妥昔单抗免疫抑制治疗，结果病情逐渐完全改善。
