An unusually dry story
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We present a middle-aged woman with a prior history of central nervous system (CNS) demyelinating disorder who presented with an acute onset quadriparesis and respiratory failure. The evaluation revealed distal renal tubular acidosis with hypokalemia and medullary nephrocalcinosis. Weakness persisted despite potassium correction, and ongoing evaluation confirmed recurrent CNS and long-segment spinal cord demyelination with anti-aquaporin-4 antibodies. There was no history of dry eyes or dry mouth. Anti-Sjogren's syndrome A antigen antibodies were elevated, and there was reduced salivary flow on scintigraphy. Coexistent antiphospholipid antibody syndrome with inferior vena cava thrombosis was also found on evaluation. The index patient highlights several rare manifestations of primary Sjogren's syndrome (pSS) as the presenting features and highlights the differential diagnosis of the clinical syndromes in which pSS should be considered in the Intensive Care Unit.

Case :
A 36-year-old lady presented with weakness of upper and lower limbs progressing to complete inability to move her limbs over a 12-h period. She did not report diplopia or urinary retention and denied any fever, neck pain, or trauma. She was a homemaker, did not smoke and denied any alcohol or substance abuse. Her medications included 100-?g levothyroxine daily. She was diagnosed with postviral encephalomyelitis 3 years ago and treated with steroids with complete resolution of symptoms and signs. She had normal menstrual cycles and had one spontaneous second trimester abortion 8 years ago. She had one living child and had undergone tubal ligation after medical termination of pregnancy 4 months prior to this presentation......
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