case_images: PMC8387908_01
case_images: COMPASS-31 final domain scores (orthostatic, vasomotor, secretomotor, gastrointestinal, bladder, pupillomotor) and the sum score before and after therapy. There was an improvement in orthostatic, vasomotor and secretomotor symptoms and in the sum score.
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case_images: PMC8387908_01_gr1.jpg
case_images: fig1
case_images: A 35-year-old Caucasian female experienced for the first-time after a severe upper respiratory infection progressive, symptoms of orthostatic dysregulation including orthostatic headaches, near fainting and fainting, cognitive impairment, restlessness and fatigue after standing, prolonged sitting or after short walks (Fig. 1). After a total of 11 cycles of 1 g/kg IVIg every 4-8 weeks over 3 days a gradual improvement of fatigue, dizziness and near fainting was reported (Fig. 1).
case_images: Whereas heart rate parameters in tilt table examination and daytime sleepiness (ESS = Epworth sleepiness Scale) did not worsen over time, orthostatic symptoms (sum score of points of the Winker Scale) improved by therapy. Orthostatic intolerance improved from 3 points before therapy (orthostatic symptoms occur in most occasions and orthostatic stress regularly produces symptoms, impairment of daily activities, standing time about 1 min) to 2 points (orthostatic symptoms occur frequently, at least once a week and orthostatic stress usually produces symptoms, standing time about 5 minutes). HF=Heart rate.
case_images: gr2.jpg
case_images: PMC8387908_01_gr2.jpg
case_images: fig2
case_images: Whereas heart rate parameters in tilt table examination and daytime sleepiness did not worsen over time, orthostatic symptoms improved by therapy (Fig. 2).
case_images: Quantitative sensory testing before and after treatment: the z-profile in QST at the left side shows a central sensitization before treatment (gain of function in PPT and MPS, 2 paradoxical heat sensations), which improves under therapy. Hyperalgesia (gain of function in MPT) and hypesthesia (loss of function in MDT and CDT) developed over time. CDT = cold detection threshold; WDT = warm detection threshold; TSL = thermal sensory limen; CPT = cold pain threshold; HPT = heat pain threshold; MDT = mechanical detection threshold; MPT = mechanical pain threshold; MPS = mechanical pain sensitivity; WUR = wind-up ratio; VDT = vibration detection threshold; PPT = pressure pain threshold; DMA = dynamic mechanical allodynia; PHS = paradoxical heat sensation.
case_images: gr3.jpg
case_images: PMC8387908_01_gr3.jpg
case_images: fig3
case_images: Central sensitization before treatment improved under therapy (Fig. 3). 24h electrocardiogram (heart rate of 55-130 bpm, no fainting) and 24h blood pressure measurement confirmed the clinical findings.