ABSTRACT
Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8â mEq/L (normal range 3.5-5), free T4 of 29.2â pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of <0.01â mIU/L (normal range 0.35-4.94). Random urinary potassium was 8.8â mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24â h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic.
Subject(s)
Hypokalemia/etiology , Hypokalemic Periodic Paralysis/etiology , Muscle Weakness/etiology , Potassium/therapeutic use , Thyrotoxicosis/complications , Thyrotropin/blood , Adult , Antithyroid Agents/therapeutic use , Arrhythmias, Cardiac/etiology , Brugada Syndrome , Carbimazole/therapeutic use , Cardiac Conduction System Disease , Heart Conduction System/abnormalities , Humans , Hypokalemia/blood , Hypokalemia/drug therapy , Hypokalemic Periodic Paralysis/blood , Hypokalemic Periodic Paralysis/diagnosis , Hypokalemic Periodic Paralysis/drug therapy , Male , Muscle Weakness/blood , Muscle Weakness/diagnosis , Muscle Weakness/drug therapy , Paralysis/blood , Paralysis/diagnosis , Paralysis/drug therapy , Paralysis/etiology , Potassium/blood , Propranolol/therapeutic use , Thyrotoxicosis/drug therapy , Thyrotoxicosis/metabolismABSTRACT
We report the case of a patient with Rheumatoid Arthritis [RA] presenting with clinical-pathological and radiological features of Pulmonary Lymphomatoid Granulomatosis (PLG). This is a rare lung disorder characterized by multiple nodular lesions with lymphocytic invasion of vascular walls. We present one such case of PLG secondary to Methotrexate and Azathioprine therapy, who was successfully treated with Steroids and Rituximab. We wish to highlight the importance of lung biopsy in the diagnosis and the use of rituximab as a treatment modality for RA as well as PLG.
