Immunoresponsive Postinfectious Autonomic Neuropathy
Abstract
A 36-year-old healthy woman developed a postinfectious autonomic neuropathy with adrenergic failure and symptoms of orthostatic intolerance. Treatment with immunomodulating therapy, including corticosteroids and immunoglobulin, resulted in marked improvement in clinical symptoms and findings on autonomic testing.
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Anecdotal evidence from case reports and retrospective case series suggests that IVIG may be effective in refractory POTS and other suspected autoimmune dysautonomia.
“Further, a number of case reports, and retrospective case series have provided anecdotal evidence suggesting efficacy of IVIG in the treatment of refractory POTS and other forms of suspected autoimmune dysautonomia (Goodman, 2014; Schofield and Chemali, 2019; Weinstock et al., 2018).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Goodman, 2014
Cites
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-011-0119-5 · Cited by 1,697 · cited 1× · see citing works
“PoTS is characterized by a postural tachycardia exceeding 30 bpm within 10 minutes of standing or head-up tilt on tilt-table testing, in the absence of orthostatic hypotension.(2,3) Symptoms other than those of orthostatic intolerance are frequently reported in patients with PoTS, including headaches, gastrointestinal…”
BackgroundPostural orthostatic tachycardia syndrome: the Mayo clinic experience
Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., Low, P. A., Lennon, V. A., & Shen, W.-K. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)61027-6 · Cited by 516 · see citing works
Cardiac origins of the postural orthostatic tachycardia syndrome
Fu, Q., VanGundy, T. B., Galbreath, M. M., Shibata, S., Jain, M., Hastings, J. L., Bhella, P. S., & Levine, B. D. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.02.043 · Cited by 329 · see citing works
Postural tachycardia syndrome—current experience and concepts
Mathias, C. J., Low, D. A., Iodice, V., Owens, A. P., Kirbis, M., & Grahame, R. (2012) · Nature Reviews Neurology · doi:10.1038/nrneurol.2011.187 · Cited by 251 · cited 2× · see citing works
“Symptoms other than those of orthostatic intolerance are frequently reported in patients with PoTS, including headaches, gastrointestinal symptoms, genitourinary symptoms, and myofascial pain.(2,4) An antecedent infectious illness is frequently reported in patients with PoTS.”
BackgroundPostural Tachycardia Syndrome: Clinical Features and Follow-up Study
Sandroni, P., Opfer-Gehrking, T. L., McPhee, B. R., & Low, P. A. (1999) · Mayo Clinic Proceedings · doi:10.4065/74.11.1106 · Cited by 194 · see citing works
Pharmacological dissection of components of the Valsalva maneuver in adrenergic failure
Sandroni, P., Benarroch, E. E., & Low, P. A. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.71.4.1563 · Cited by 189 · see citing works
Fu, Q., VanGundy, T. B., Shibata, S., Auchus, R. J., Williams, G. H., & Levine, B. D. (2011) · Hypertension · doi:10.1161/hypertensionaha.111.172262 · Cited by 175 · see citing works
Idiopathic autonomic neuropathy: Clinical, neurophysiologie, and follow‐up studies on 27 patients
Suarez, G. A., Fealey, R. D., Camilleri, M., & Low, P. A. (1994) · Neurology · doi:10.1212/wnl.44.9.1675 · Cited by 171 · see citing works
Low, P. A., Dyck, P. J. B., Lambert, E. H., et al. (1983) · Annals of Neurology · doi:10.1002/ana.410130407 · Cited by 96 · see citing works
Fagius, J., Westerberg, C.-E., & Olsson, Y. (1983) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.46.8.725 · Cited by 59 · see citing works
Acute autonomic neuropathy following primary herpes simplex infection.
Neville, B. G. R., & Sladen, G. E. (1984) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.47.6.648 · Cited by 45 · see citing works
Unusual Recovery From Acute Panautonomic Neuropathy After Immunoglobulin Therapy
Smit, A. A. J., Vermeulen, M., Koelman, J. H. T. M., & Wieling, W. (1997) · Mayo Clinic Proceedings · doi:10.4065/72.4.333 · Cited by 38 · see citing works
Long-term follow-up of patients with postural tachycardia syndrome
Sousa, A., Lebreiro, A., Freitas, J., & Maciel, M. J. (2012) · Clinical Autonomic Research · doi:10.1007/s10286-011-0155-1 · Cited by 38 · see citing works
Orthostatic heart rate responses after prolonged space flights
Tank, J., Baevsky, R. M., Funtova, I. I., Diedrich, A., Slepchenkova, I. N., & Jordan, J. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-010-0106-2 · Cited by 32 · see citing works
Effect of mild hyperglycemia on autonomic function in obstructive sleep apnea
Peltier, A., Bagai, K., Artibee, K. J., Diedrich, A., Garland, E. M., Elasy, T. A., Shi, Y., Wang, L., Feldman, E. L., Robertson, D., et al. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-011-0131-9 · Cited by 11 · see citing works
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Vernino, S., Bourne, K. M., Stiles, L. E., Grubb, B. P., Fedorowski, A., Stewart, J. M., Arnold, A. C., Pace, L. A., Axelsson, J., Boris, J. R., et al. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102828 · Cited by 304 · see citing works
“Further, a number of case reports, and retrospective case series have provided anecdotal evidence suggesting efficacy of IVIG in the treatment of refractory POTS and other forms of suspected autoimmune dysautonomia (Goodman, 2014; Schofield and Chemali, 2019; Weinstock et al., 2018).”
BackgroundSelf-citation
- Authors
- Goodman, B. P.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Goodman, Brent P.
- Venue
- American Journal of Therapeutics
- Published
- 2014-07
- Volume
- 21
- Issue
- 4
- Pages
- e120-e123
- ISSN
- 1075-2765 (ISSN-L)
- OpenAlex
- W2322404242
- Cited by
- 6
- References
- 15
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2018: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Keywords
- orthostatic intolerance, immunomodulatory therapy, corticosteroids, intravenous immunoglobulin, autonomic function testing, autoimmune neuropathy
- MeSH terms
- Adult, Autonomic Nervous System Diseases, Female, Glucocorticoids, Humans, Infections, Immunoglobulins, Intravenous, Treatment Outcome
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