Abstract
Objective: To report a case series of dysautonomia associated with COVID-19 infection.Methods: This is a retrospective review of patients evaluated in the autonomic clinic at our institution with suspected signs and symptoms of dysautonomia who underwent formal evaluation, including autonomic testing.Results: Six patients were identified with signs and symptoms suggestive of dysautonomia who underwent autonomic testing. All patients had symptoms typical of COVID-19 infection, though none were hospitalized for these or other symptoms. All patients reported symptoms of postural lightheadedness and near-syncope, fatigue, and activity intolerance. Five patients reported the onset of autonomic symptoms concomitant with other COVID-19 symptoms, with the other patient reporting symptom onset 6 weeks following initial COVID-19 symptoms. Autonomic testing demonstrated an excessive postural tachycardia in 4 patients, a hypertensive response with head-up tilt in 3 patients, orthostatic hypotension in 1 patient, and sudomotor impairment in 1 of the patients with excessive postural tachycardia.Conclusions: We present clinical features and results of autonomic testing in 6 patients with a history COVID-19 infection. While all patients reported typical features of orthostatic intolerance, fatigue, and activity intolerance, the results of autonomic testing were heterogenous, with orthostatic hypotension in 1 patient, excessive postural tachycardia typical of postural tachycardia syndrome in 4 patients, and postural hypertension in 3 patients.
Highlights
The clinical spectrum and consequences of the worldwide pandemic due to coronavirus disease 2019 (COVID-19) are being collated
None of the patients were hospitalized for COVID-19 infectious symptoms, and none of the patients were diagnosed with pneumonia
None of the patients reported a history of antecedent autoimmune disease, aside from 1 patient with eczema, and none of the patients reported an antecedent history of a chronic medical condition with the potential to result in deconditioning or of autonomic dysfunction
Summary
The clinical spectrum and consequences of the worldwide pandemic due to coronavirus disease 2019 (COVID-19) are being collated. Neurological manifestations resulting from infection by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitalized patients have been a focus of early studies [1,2,3]. There is at present even less understanding of the potential medical and neurological sequelae in non-hospitalized COVID-19 patients, and individuals with persistent symptoms following SARS-CoV-2 infection. We report the clinical features and results of formal autonomic testing in a cohort of non-hospitalized COVID-19 patients with persistent, disabling symptoms due to dysautonomia. That dysautonomia should occur in conjunction with or following COVID-19 should be expected, given a reported prevalence of dysautonomia in 50% of severe acute respiratory syndrome (SARS) patients studied in the 2002 SARS epidemic [4], and that the most prevalent, primary autonomic disorder, postural tachycardia syndrome (POTS), is commonly associated with antecedent or concomitant infection
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