Hypokalemic Paralysis: A Hidden Card of Several Autoimmune Diseases

Acute hypokalemic paralysis is a rare and potentially fatal condition, with few related causes, one of which highlights distal renal tubular acidosis (dRTA). Distal renal tubular acidosis is a rare complication of several autoimmune diseases such as systemic lupus erythematosus, Sjögren’s syndrome, and Hashimoto thyroiditis. We report a case of a lupic patient who presented rapidly progressive quadriparesis in the context of active renal disease. Research revealed severe refractory hypokalemia, metabolic acidosis, and alkaline urine suggestive of dRTA. We diagnosed Sjögren’s syndrome based on sicca symptoms, an abnormal salivary glands’ nuclear scan and the presence of anti-Ro/SSA and anti-La/SSB. In addition, the finding of thyroid peroxidase, thyroglobulin antibodies, and hypothyroidism led us to the diagnosis of Hashimoto thyroiditis. Due to the active renal involvement on the context of systemic lupus erythematosus and Sjögren’s syndrome, the patient received immunosuppression with rituximab, resulting in a progressive and complete improvement

Biopsia de Grasa Subcutánea para el Diagnóstico de Amiloidosis Secundaria en Artritis Reumatoide

OBJECTIVE: To detect secondary amyloidosis (AA) in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: We assayed length of disease, extraarticular involvement, functional ability, anatomical compromise, white cell count, erythrocyte sedimentation rate, rheumatoid factor (RF) (latex test), serum albumin, and urine analysis. All of patients underwent periumbilical aspirate of subcutaneous fat. Samples were stained with Congo red, and light microscopy and polarized microscopy were used. Green-apple birefrigence was taken as AA (+). RESULTS: We studied 81 patients with RA (ACR criteria), 71 of them were females. The ages were between 31 and 80 years. 75/81 patients were RF (+), 3/81 were AA (+). Average length of disease was 14,74 years in AA (-) patients and 20,3 years in AA (+). Just one patient showed renal deposits of amyloid. CONCLUSION: Our occurrence of amyloidosis in patients with AR was lower. Patients with secondary amiloidosis and AR had higher RF levels and larger length of disease.OBJETIVO: Investigar la presencia de amiloidosis secundaria (AA) en pacientes con diagnóstico de artritis reumatoide (AR). MATERIALES Y MÉTODOS: Se evaluó tiempo de enfermedad (TE), presencia de manifestaciones extraarticulares, capacidad funcional y estadio de progresión anatómica, hemograma, velocidad de sedimentación globular, factor reumatoide (FR) (Test de Látex), albúmina sérica y examen completo de orina. Se realizó aspirado de grasa subcutánea periumbilical. El tejido se coloreó con rojo Congo y observó por microscopía óptica y luz polarizada, siendo positiva la birrefringencia verde manzana. RESULTADOS: Se estudió 81 pacientes con diagnóstico de AR (criterios del ACR), 71 fueron mujeres y 10 varones, con rango de edad 31 a 80 años. 75/81 fueron FR (+), 3/81 AA (+). El TE promedio fue 14,74 años para los AA (-) y 20,3 para los AA (+). Sólo en un paciente se halló amiloide en biopsia renal. CONCLUSIONES: En nuestra serie la frecuencia fue menor a lo reportado. Los pacientes con amiloidosis tuvieron títulos altos de FR y TE más prolongado