Quadriparesis as a Presentation of Sjögren Syndrome-Induced Distal Renal Tubular Acidosis with Hypokalemia and Osteomalacia

Sjögren syndrome is a systemic autoimmune disease primarily affecting the salivary and lacrimal glands, commonly presenting with dry eyes and dry mouth. While exocrine gland involvement is typical, extraglandular manifestations such as renal tubular acidosis (RTA) can occur, leading to metabolic disturbances. Distal RTA is the predominant renal complication in Sjögren syndrome and may cause hypokalemia severe enough to result in neuromuscular symptoms like quadriparesis. Additionally, chronic RTA contributes to osteomalacia, characterized by impaired bone mineralization and the development of pseudofractures (Looser zones). We report the case of a 31-year-old female with a 10-year history of recurrent hypokalemia and episodes of quadriparesis who presented with thigh pain and difficulty walking. Clinical evaluation revealed sicca symptoms, positive anti-Ro/SSA antibodies and laboratory evidence of distal RTA with hypokalemia and metabolic acidosis. Radiological studies showed bilateral subtrochanteric impending fractures consistent with osteomalacia. She underwent prophylactic orthopedic fixation and was treated with potassium and alkali supplementation, along with immunosuppressive therapy for Sjögren syndrome. This case highlights the diagnostic challenges of atypical presentations of Sjögren syndrome and underscores the importance of considering systemic complications such as distal RTA and osteomalacia. Early recognition and comprehensive management are crucial to prevent severe morbidity.