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CASE REPORT article

Front. Neurosci.
Sec. Autonomic Neuroscience
Volume 18 - 2024 | doi: 10.3389/fnins.2024.1505727
This article is part of the Research Topic An Update on Neurological Disorders Post COVID-19 Infection Vol 2: cardiovascular effects, neuro-cardiac and neuro-respiratory autonomic dysfunctions View all 9 articles

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

Provisionally accepted
Kenji Theiler Kenji Theiler 1*Maroussia Bronchain Maroussia Bronchain 2Serge Duflon Serge Duflon 2Lorenz Hirt Lorenz Hirt 2Renaud Du Pasquier Renaud Du Pasquier 2Gérard Waeber Gérard Waeber 3Gregoire Wuerzner Gregoire Wuerzner 1Karin Diserens, Professor Karin Diserens, Professor 4Julien F Bally Julien F Bally 2
  • 1 Service de Néphrologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • 2 Division de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland
  • 3 Service de Médecine Interne, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland
  • 4 Unité de réadaptation neurologique aiguë, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Vaud, Switzerland

The final, formatted version of the article will be published soon.

    We report a patient with autonomic dysfunction after acute SARS-CoV-2 infection, presenting as progressive worsening of severe orthostatic hypotension, to the point where they could no longer sit or stand up. The patient experienced diagnosis delay after an initial wrong diagnosis of a functional neurological disorder. Persistent orthostatic symptoms made us re-examine this diagnosis and look for other diagnostic tools, allowing us to eventually prove and treat a severe orthostatic hypotension that was immune-mediated. We identified autoantibodies targeting the autonomic nervous system. Intravascular immunoglobulin therapy, coupled 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, causing unnecessary and costly ancillary examinations leading to delays in diagnosis or misdiagnoses. Further, lack of awareness of rare complications of new diseases may also hamper proper patient care; in the present case the wide array of SARS-CoV-2 infection manifestations, including immune-mediated autonomic complications.

    Keywords: Autoantibodies, COVID-19, orthostatic hypotension, Intravascular immunoglobulin therapy, dysautonomia, Rehabilitation

    Received: 03 Oct 2024; Accepted: 09 Dec 2024.

    Copyright: © 2024 Theiler, Bronchain, Duflon, Hirt, Du Pasquier, Waeber, Wuerzner, Diserens, Professor and Bally. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kenji Theiler, Service de Néphrologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.