Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report.
Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report.
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DOI：
10.1016/j.ensci.2020.100276
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Novak P
中科院分区：
文献类型：
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作者：
Novak P
冠状病毒病（COVID-19）是由冠状病毒SARS-CoV 2引起的一种新型高度接触性传染病。该病毒影响人类呼吸系统和其他系统，主要表现为急性呼吸系统综合征，伴有发热、疲劳、干咳、肌痛和呼吸困难。临床表现从无症状到多器官功能衰竭不等。大多数患者完全康复。据报道，COVID-19的几种感染后可能的自身免疫性并发症影响了大脑或外周大神经纤维。本报告描述了一名COVID-19后患者，其出现慢性疲劳、直立性头晕和脑雾，与直立性低灌注综合征（OCHOS）一致，OCHOS是一种直立性不耐受和疼痛性小纤维神经病（SFN）。最初，患者被诊断为。OCHOS（通过倾斜试验和经颅多普勒监测检测）和SFN（通过皮肤活检证实）以及OCHOS/SFN均归因于治疗后莱姆病综合征，推测为自身免疫性病因。患者接受对症治疗后痊愈。COVID-19引发的OCHOS/SFN恶化对静脉注射免疫球蛋白的免疫治疗有反应。该病例表明，COVID-19后综合征可能以自身免疫性OCHOS/SFN的形式存在，早期免疫治疗可能有效。需要进一步的研究来确认OCHOS/SFN与COVID-19疾病之间的联系，以及确认免疫治疗的益处。COVID-19后综合征与疲劳、脑雾和疼痛有关。直立性脑灌注不足综合征（OCHOS）可导致COVID-19后综合征中的疲劳和脑雾。小纤维神经病（SFN）可能是COVID-19后综合征疼痛的原因。COVID-19后综合征中的OCHOS和SFN可能具有自身免疫基础，早期静脉注射免疫球蛋白免疫治疗可能有效。
Coronavirus disease (COVID-19) is a novel highly contagious infectious disease caused by the coronavirus SARS-CoV2. The virus affects the human respiratory and other systems, and presents mostly as acute respiratory syndrome with fever, fatigue, dry cough, myalgia and dyspnea. The clinical manifestations vary from no symptoms to multiple organ failure. Majority of patients fully recover. Several postinfectious presumably autoimmune complications of COVID-19 affecting the brain or peripheral large nerve fibers have been reported. This report describes a post COVID-19 patient who developed chronic fatigue, orthostatic dizziness and brain fog consistent with orthostatic hypoperfusion syndrome (OCHOS), a form of orthostatic intolerance, and painful small fiber neuropathy (SFN). Initially, the patient was diagnosed with. OCHOS (detected by the tilt test with transcranial Doppler monitoring) and SFN (confirmed by skin biopsy), and both OCHOS/SFN were attributed to Post Treatment Lyme Disease Syndrome of presumed autoimmune etiology. Patient recovered on symptomatic therapy. COVID-19 triggered exacerbation of OCHOS/SFN responded to immunotherapy with intravenous immunoglobulins. This case suggests that post COVID-19 syndrome may present as an autoimmune OCHOS/SFN and that early immunotherapy may be effective. Further studies are necessary to confirm the link between OCHOS/SFN and COVID-19 disease as well as to confirm the benefit of immunotherapy. Post COVID-19 syndrome is associated with fatigue, brain fog and pain. Orthostatic cerebral hypoperfusion syndrome (OCHOS) can be responsible for fatigue and brain fog in post COVID-19 syndrome. Small fiber neuropathy (SFN) can be responsible for pain in post COVID-19 syndrome. OCHOS and SFN in post COVID-19 syndrome may have autoimmune basis and early immunotherapy with intravenous immunoglobulins may be effective.