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

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

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 18 - 2024

YEAR=2025

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2024.1505727

DOI=10.3389/fnins.2024.1505727

ISSN=1662-453X

ABSTRACT=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.