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

• Published in: Journal of medical case reports 2024-05, Vol.18 (1), p.236-6, Article 236
• Main Authors: Sundarsingh, Vijay, Kumar, R Manoj, Kulkarni, Manjunath, Mammoo, Firas Rauf, Rodrigues, Pramela Renisha, Prashanth, Y M
• Format: Article
• Language: English
• Subjects: Acidosis, Renal Tubular - complications; Acidosis, Renal Tubular - diagnosis; Acidosis, Respiratory - etiology; Adult; Electrolytes; Female; Humans; Hypokalemia - etiology; Leptospirosis - complications; Leptospirosis - diagnosis; Physiological aspects; Pregnancy; Pregnancy Complications - diagnosis; Pregnant women; Quadriplegia - etiology; Renal tubular acidosis; Respiratory failure; Severe hypokalaemia; Sjogren's Syndrome - complications; Sjogren's Syndrome - diagnosis; Sjogren's Syndrome - physiopathology; Sjogren’s syndrome (SS)
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-024-04563-7

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. 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. 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.