Treatment of postural orthostatic tachycardia syndrome and management of myalgic encephalomyelitis/chronic fatigue syndrome following suspected West Nile virus infection

Abstract

ABSTRACT Background: Postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been associated with a variety of viral triggers, but to the best of our knowledge, cases following West Nile virus (WNV) infection are not yet reported in the literature. Here we present a case meeting the criteria for POTS, ME/CFS, and fibromyalgia following a likely WNV infection. Purpose: To present a case suggesting WNV as another possible trigger of POTS and ME/CFS, and to highlight the importance of POTS evaluation and treatment. Methods: The patient presented to a chronic fatigue clinic in 2012. Multiple behavioral and pharmaceutical interventions were integrated, particularly targeting POTS symptoms. Results: As the patient’s POTS symptoms significantly diminished, widespread pain was eliminated, and fitness and function improved. The patient still manages ME/CFS symptoms, although post-exertional malaise is less severe. Conclusions: This case report demonstrates the importance of the evaluation and treatment for POTS in presentations of chronic fatigue. This case also contributes to the list of possible viral triggers of POTS and ME/CFS and enduring consequences of acute flavivirus infection. These findings are important from a public health standpoint since WNV has become the most common arboviral infection in the U.S.A.