An unusual presentation of Sjögren's syndrome

A 44-year-old woman presented with a long history of nausea and vomiting and was found to have hypokalemic metabolic acidosis with elevation of the urine bicarbonate level consistent with the new onset of renal tubular acidosis, type I. Her laboratory findings and histologic picture of a buccal biopsy sample of two minor salivary glands were consistent with Sjögren's syndrome. Treatment with steroids markedly improved her symptoms.