Clinical Associate Johns Hopkins University Baltimore, Maryland, United States
Case Diagnosis: Postural Orthostatic Tachycardia Syndrome (POTS)
Case Description: Case #1 47 year-old female was tested positive for COVID-19 in April 2020. She developed severe upper respiratory symptoms that lasted about 2 weeks. She fully recovered from COVID19 infection initially. In mid-June, she developed acute onset of severe fatigue, orthostatic intolerance, and brain fog. Orthostatic vital signs showed heart rate of 63 on sitting that increases to 127 bpm on standing within 10 minutes, while reproducing her typical symptoms. The diagnosis of POTS was made, and she has responded to volume expansion therapy.
Case #2 47 year-old female developed a pneumonia from COVID-19 in April 2020 that lasted for 33 days. About one week after the resolution of her initial symptoms, she developed severe fatigue, exertional dyspnea, and chronic vomiting. During a tilt table test, her hear rate increased from 79 to 118 bpm within 10 minutes, while reproducing her typical symptoms. POTS was confirmed.
Discussions: Increasing number of long-lasting neurological symptoms have been reported after resolution of COVID-19 infection. The pathophysiology of the post-COVID syndrome, also known as “long haulers”, is unknown, but there is emerging evidence of involvement of autonomic nervous system in this population. Here we present two cases where patients developed POTS after COVID-19 infection. POTS can occur from inflammation of sympathetic ganglia that results in vasomotor dysfunction, and up to 50% POTS is thought to be immune-mediated in nature. We believe POTS is potentially a debilitating complication from COVID-19 infection.
Conclusions: Postural Orthostatic Tachycardia Syndrome (POTS) can occur as a long-lasting neurological complication of COVID-19 infection