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

## TL;DR

A pregnant woman with Sjogren’s syndrome experienced severe electrolyte imbalance and required urgent treatment, highlighting the risks of autoimmune diseases during pregnancy.

## Contribution

This case report highlights the rare and complex presentation of Sjogren’s syndrome during pregnancy, emphasizing the need for timely diagnosis and management.

## Key findings

- The patient presented with severe hypokalaemia and respiratory acidosis requiring intubation.
- Positive autoimmune markers confirmed Sjogren’s syndrome alongside IgM Leptospira positivity.
- Aggressive electrolyte correction and treatment of underlying conditions improved the patient’s condition.

## Abstract

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.