A case report of postural tachycardia syndrome after COVID-19
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LETTER TO THE EDITOR
A case report of postural tachycardia syndrome after COVID‑19 Mitchell G. Miglis1 · Thomas Prieto1 · Ruba Shaik1 · Srikanth Muppidi1 · Dong‑In Sinn1 · Safwan Jaradeh1 Received: 4 August 2020 / Accepted: 28 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editors, The most common symptoms of coronavirus disease 19 (COVID-19) from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include fever, cough, sore throat, and fatigue. As case numbers grow, neurological symptoms have been reported with increasing frequency, including those of autonomic dysfunction [1]. Most neurological reports detail symptoms in hospitalized patients during the para-infectious period; thus, understanding of longer-term, post-infectious sequalae is limited. We report the case of a patient who developed postural tachycardia syndrome (POTS) several months after confirmed SARSCoV-2 infection. In early March of 2020, a 26-year-old emergency department nurse in Orange County, California developed a mild cough and an itchy throat. She woke the next day with palpitations, fatigue, and mild shortness of breath. On day 3 she presented to urgent care and had a nasopharyngeal swab which returned negative for SARS-CoV-2 PCR. On day 7 she woke up with palpitations, shortness of breath, and anorexia. She noted that her resting seated HR was 110 bpm and would increase to 190 bpm after walking up a flight of stairs. Her cough worsened and she developed burning chest pains on inhalation. She presented to the emergency department for evaluation, where her temperature was 100.4 ℉ and her SaO2 98%. A chest CT was performed and demonstrated moderate bronchitis with right lower lobe atelectasis. Her SARS-CoV nasopharyngeal swab was repeated and returned positive. IgG and IgM antibodies to the SARS-CoV-2 spike
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10286-020-00727-9) contains supplementary material, which is available to authorized users. * Mitchell G. Miglis [email protected] 1
Department of Neurology and Neurological Science, Autonomic Division, Stanford University, 213 Quarry Road, Palo Alto, CA 94304, USA
receptor binding domain (RBD) also returned positive. She was given IV fluids, a 5-day prescription of azithromycin, and discharged home. Over the following week she noted continued tachycardia (standing HR of 150 bpm after showering), chest pains, shortness of breath, fatigue and exercise intolerance, along with subjective fevers and insomnia. Her seated, resting BP increased to 156/112 mmHg (her typical seated, resting BP was 110/60 mmHg). On day 19 she developed orthostatic lightheadedness and presyncope. She returned to the emergency department for evaluation, where her seated BP was 146/100 mmHg, HR was 125 bpm, and SaO2 dropped from 98% to 94% with minimal exertion. She was given IV fluids, kept overnight, and discharged the following day. On day 22 she developed symptoms of hyperactivity with pressured speech and
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