(PO-180) A case of post-COVID dysautonomia disguised as somatic symptom disorder
Background/Significance: Coronavirus disease 2019 (COVID-19) has demonstrated systemic involvement with potential for post-acute sequelae including dysautonomia. Identification of this primarily clinical syndrome is essential when evaluating for possible psychiatric comorbidities. We present a case where psychiatry was consulted because for suspicion of a Somatic Symptom Disorder (SSD) in a 9 year old female patient who was ultimately diagnosed with post-viral dysautonomia secondary to COVID-19.
Case: Ms. X is a 9 year old female with no past psychiatric history and a developmental history significant for an Expressive Language Delay. She presented to our hospital for intractable headaches, vision distortions, and abdominal pain that began several weeks following an acute COVID-19 infection. Symptoms were refractory to all interventions, with an unremarkable, comprehensive medical work up. Psychiatry was consulted due to contributing psychosocial stressors and concern for a SSD. During the admission, the patient began to additionally experience worsening vomiting and vital sign instability. IVIG was initiated with partial improvement of symptoms and the patient was discharged home with a presumed diagnosis of post-viral dysautonomia secondary to COVID-19. Presentation will include a relevant literature review of observed presentations and treatment options.
Discussion: Data on the long term sequela of COVID-19 infection is still emerging. Dysautonomias, defined as changes in the functioning of at least one component of the autonomic nervous system (ANS), can have clinical manifestations ranging from blood pressure lability to alterations in bowel and bladder function. Acute post-viral dysautonomias have previously been reported following viruses including HIV, hepatitis, Epstein-Barr virus and Coxsackie B virus and emerging research suggests that COVID-19 places patients at risk of dysautonomic sequela as well (Eshak, 2020). Our case highlights an example of dysautonomia in a pediatric patient, however, these syndromes can impact patients across the lifespan. There is a risk for novel presentations and symptoms that do not respond to standard interventions to be labeled as psychosomatic in nature. Psychiatric clinicians working in the consult liaison role must become familiar with these potential COVID-19 sequela to adequately evaluate medically complex patients. Additionally, clinicians can play an important role in helping patients cope with the stress and uncertainty of persistent and difficult to manage symptoms (Dani, 2021; Carfi, 2020).
Conclusion/Implications: CL psychiatrists need to be up to date with the current literature on post-viral syndromes, including but not limited to COVID-19, as we liaise with our multidisciplinary colleagues.
Recognize common features of post-viral dysautonomic syndromes
Contrast distinguishing features of a somatic symptom disorder versus post-viral sequela of COVID-19
Recognize value of psychiatry’s role in supporting patients with an uncertain diagnostic picture