Sjögren’s syndrome and hepatitis C virus infection presenting as hypokalemic quadriparesis: A case report

Distal renal tubular acidosis can present with acute-onset quadriparesis caused by severe hypokalemia, and primary Sjögren's syndrome is a significant potential cause of distal renal tubular acidosis in such patients. The extrahepatic manifestations of chronic hepatitis C virus infection can mimic those of primary Sjögren's syndrome, creating a diagnostic dilemma. Here, we present the case of a woman in her mid-20s who presented with sudden-onset quadriparesis. Laboratory investigations showed severe hypokalemia, normal anion gap metabolic acidosis, and positivity for antinuclear and anti-Ro/Sjögren's syndrome-related antigen A antibodies. Further evaluation confirmed a positive hepatitis C virus antibody test but a negative viral load. A diagnosis of primary Sjögren's syndrome with distal renal tubular acidosis was established, accounting for the hypokalemia. Potassium supplementation and correction of acid-base disturbances led to significant patient improvement. This case highlights the importance of including autoimmune conditions such as primary Sjögren's syndrome in the differential diagnosis of patients presenting with hypokalemic quadriparesis and distal renal tubular acidosis, even in the absence of glandular symptoms. Early diagnosis and management are essential to improve outcomes.