SHM Converge Scientific Abstract ePoster Gallery-Sjogren's Syndrome Associated With Rhabdomyolysis, Hypokalemia and Renal Tubular Acidosis:

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A 37-year-old woman with obesity status post bariatric surgery and hypothyroidism presented with progressive generalized weakness and recurrent episodes of rhabdomyolysis. During repeated hospitalizations, she was found to have persistently elevated creatine kinase (CK), hypokalemia, and metabolic acidosis despite intravenous hydration. She also reported dry eyes and mouth, joint pain, and prolonged morning stiffness. Rheumatology evaluation showed strongly positive SSA/Ro antibodies, leading to a diagnosis of Sjögren’s syndrome.<br /><br />Additional testing revealed acute kidney injury, hypokalemia, and hyperchloremic metabolic acidosis, consistent with distal renal tubular acidosis (RTA type 1), likely due to Sjögren’s-related renal involvement. Her CK was 1847, potassium 3.3, chloride 112, and CO2 18. She was treated with prednisone and mycophenolate, with improvement in rhabdomyolysis, potassium levels, and acid-base status.<br /><br />The discussion emphasizes that rhabdomyolysis can result from many causes, including trauma, medications, infection, electrolyte disorders, and endocrine conditions, but recurrent rhabdomyolysis without another clear explanation should prompt consideration of Sjögren’s syndrome. Sjögren’s is a chronic autoimmune disease that can cause extra-glandular renal manifestations such as interstitial nephritis and distal RTA. Distal RTA commonly leads to hypokalemia, which can cause muscle injury and, when severe, rhabdomyolysis.<br /><br />The key conclusion is that patients presenting with the combination of rhabdomyolysis, hypokalemia, and metabolic acidosis should be evaluated for Sjögren’s syndrome so treatment can begin promptly.

Asset Subtitle

Prodip Paul

Meta Tag

Author List Birendra Amgai, Julio Ramos, Mishouri Paul, Prodip Paul

Category Clinical Vignettes

Concept Sjogren Syndrome

Concept Rhabdomyolysis

Concept Hypokalemia

Concept Distal Renal Tubular Acidosis

Concept Metabolic Acidosis

Distinguished Non-Finalist

Presenter Organization Geisinger Community Medical Center, Scranton, PA

Presenting Author Prodip Paul

Track Adult

Keywords

Sjögren’s syndrome

rhabdomyolysis

hypokalemia

distal renal tubular acidosis

metabolic acidosis

creatine kinase

autoimmune disease

SSA/Ro antibodies

renal involvement

mycophenolate

Sjogren Syndrome

Rhabdomyolysis

Hypokalemia

Distal Renal Tubular Acidosis

Metabolic Acidosis