Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection
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 neuro...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2024.1505727/full |
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| author | Kenji Theiler Maroussia Bronchain Eric Grouzmann Serge Duflon Lorenz Hirt Renaud Du Pasquier Gérard Waeber Grégoire Wuerzner Karin Diserens Julien F. Bally |
| author_facet | Kenji Theiler Maroussia Bronchain Eric Grouzmann Serge Duflon Lorenz Hirt Renaud Du Pasquier Gérard Waeber Grégoire Wuerzner Karin Diserens Julien F. Bally |
| author_sort | Kenji Theiler |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-e799ecc7bfc14c08992978ef933187dd |
| institution | OA Journals |
| issn | 1662-453X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj-art-e799ecc7bfc14c08992978ef933187dd2025-08-20T01:48:20ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2025-01-011810.3389/fnins.2024.15057271505727Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infectionKenji Theiler0Maroussia Bronchain1Eric Grouzmann2Serge Duflon3Lorenz Hirt4Renaud Du Pasquier5Gérard Waeber6Grégoire Wuerzner7Karin Diserens8Julien F. Bally9Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandLaboratory of Catecholamines and Peptides, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandDepartment of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandAcute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandService of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, SwitzerlandWe 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.https://www.frontiersin.org/articles/10.3389/fnins.2024.1505727/fullautoantibodiesCOVID-19orthostatic hypotensionintravascular immunoglobulin therapydysautonomiarehabilitation |
| spellingShingle | Kenji Theiler Maroussia Bronchain Eric Grouzmann Serge Duflon Lorenz Hirt Renaud Du Pasquier Gérard Waeber Grégoire Wuerzner Karin Diserens Julien F. Bally Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection Frontiers in Neuroscience autoantibodies COVID-19 orthostatic hypotension intravascular immunoglobulin therapy dysautonomia rehabilitation |
| title | Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection |
| title_full | Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection |
| title_fullStr | Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection |
| title_full_unstemmed | Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection |
| title_short | Case report: Treatable immune-mediated severe orthostatic hypotension in SARS-CoV-2 infection |
| title_sort | case report treatable immune mediated severe orthostatic hypotension in sars cov 2 infection |
| topic | autoantibodies COVID-19 orthostatic hypotension intravascular immunoglobulin therapy dysautonomia rehabilitation |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2024.1505727/full |
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