renal tubular involvement in sjgren 's syndrome ( ss ) usually manifests with fanconi syndrome , distal ( type 1 ) renal tubular acidosis ( rta ) , nephrogenic diabetes insipidus , and hypokalemia . , we describe a case a young female with ss who presented with features of gitelman syndrome and hypokalemic paralysis . a 29-year - old female presented with weakness of both upper and lower limb weakness since 15 days . she had a history of dry eyes and dry mouth for the past 6 months . on examination , laboratory evaluation showed hemoglobin - 9.5 g / dl , platelet 2.95 lakh / mm . blood urea nitrogen was 7 mg / dl , serum creatinine was 0.65 mg / dl , serum sodium was 134 meq / l , serum potassium was 1.81 meq / l and serum chloride was 84.3 urine chloride ( spot ) was 36.7 meq / l , urine creatinine ( spot ) 23.5 mg / dl , and urine calcium ( spot ) 1.23 mg / dl . this patient satisfied the american european consensus criteria for diagnosis of primary sjgren 's syndrome ( ss ) . ten days after admission , she was discharged on spironolactone and prednisolone . on follow - up this patient presented with muscle weakness and her laboratory reports showed hypokalemia and metabolic alkalosis with normal blood pressure . her urinary chloride levels were above 20 meq / l , which ruled out extra - renal causes of metabolic alkalosis . the presence of hypomagnesemia and absence of hypercalciuria ( urinary calcium creatinine ratio < 0.2 ) ruled out bartter syndrome . hypokalemic alkalosis , high urinary chloride , hypomagnesemia , absence of hypercalciuria in background of no history of diuretic use favored the diagnosis of gitelman syndrome . tubular involvement in ss is usually distal tubular dysfunction , type i ( distal ) renal tubular acidosis and nephrogenic diabetes insipidus . proximal tubular abnormalities are less frequent , and rarely fanconi 's syndrome has been reported in patients with ss . acquired gitelman syndrome is relatively rare . to the best of our knowledge , only five cases of acquired gitelman syndrome have been reported in english literature so far . among these five cases , four had ss , one was a case of chronic sialoadenitis . acquired gitelman syndrome secondary to ss presenting with hypokalemic weakness is very rare . only two cases have been reported so far . though gitelman syndrome is an inherited disorder , given the paucity of reports , we believe that ss presenting as acquired gitelman syndrome may be relatively rare . acquired gitelman syndrome should be considered in differential diagnosis of renal involvement in patients with ss .
we report a case of a young female patient who presented with weakness of upper and lower limbs . on evaluation , she had hypokalemia , hypomagnesemia , metabolic alkalosis and hypocalciuria . 
 anti - ro ( ssa ) antibody was positive . 
 she had an acquired gitelman syndrome due to primary sjgren 's syndrome ( ss ) . 
 ss presenting with features of gitelman syndrome is very rare .