Frontiers in Neuroscience (Jan 2025)

Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection

  • Kenji Theiler,
  • Maroussia Bronchain,
  • Eric Grouzmann,
  • Serge Duflon,
  • Lorenz Hirt,
  • Renaud Du Pasquier,
  • Gérard Waeber,
  • Grégoire Wuerzner,
  • Karin Diserens,
  • Julien F. Bally

DOI
https://doi.org/10.3389/fnins.2024.1505727
Journal volume & issue
Vol. 18

Abstract

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We report a patient with autonomic dysfunction following acute SARS-CoV-2 infection, presenting progressively worsening severe orthostatic hypotension to the point where she could no longer sit or stand. The patient experienced a delay in diagnosis after an initial misdiagnosis of a functional neurological disorder. Persistent orthostatic symptoms prompted us to re-examine the diagnosis and explore other diagnostic tools, which ultimately allowed us to identify and treat severe immune-mediated orthostatic hypotension (OH). We identified autoantibodies (AAB) targeting the autonomic nervous system. Intravascular immunoglobulin therapy, along with early, specific multi-disciplinary rehabilitation, completely resolved the symptoms. Hard-to-assess patients are often penalized by suboptimal care due to the lack of a comprehensive patient history and physical examination, resulting in unnecessary and costly ancillary examinations that lead to delays in diagnosis or misdiagnoses. Furthermore, a lack of awareness of rare complications with new diseases may also hamper proper patient care. In the present case, this includes the wide range of SARS-CoV-2 infection manifestations, including immune-mediated autonomic complications.

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