Severe Hypokalemic Paralysis Unmasking Renal Tubular Acidosis in a Patient With Sjögren's Syndrome.

Hypokalemic periodic paralysis (HPP) is a rare but life-threatening complication in patients with Sjögren's syndrome (SS), often due to distal renal tubular acidosis (RTA) caused by autoimmune-mediated renal damage. We report a case of a woman in her 30s with a history of rheumatoid arthritis and SS who presented with acute, flaccid paralysis secondary to profound hypokalemia from distal RTA, requiring intensive care support. This patient was treated with central potassium and bicarbonate replacement, leading to marked clinical improvement. This report emphasizes the importance of early recognition of HPP as a manifestation of SS-related RTA and underscores why multidisciplinary management and active long-term follow-up are essential to prevent relapse and optimize patient outcomes.