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Intravenous gammaglobulin therapy for the treatment of recurrent syncope due to severe refractory postural tachycardia syndrome
Professor Blair P Grubb MD FACC FAHA
College of Medicine and Life Sciences, Ohio, USA
A 33-year-old woman was well until two months prior to presentation, when she developed a severe febrile upper respiratory tract infection.
Shortly thereafter she began to experience episodes of light headedness, near syncope and syncope. Over the next several weeks she began to experience syncope every time she attempted to stand. She was admitted to a local hospital and it was documented that upon standing, her heart rate would go from 70 bpm to 170 bpm beats per minute while at the same time her blood pressure would fall from 110/70 mmHg to unobtainable levels, at which time she would lose consciousness and display convulsive activity.
She did not respond to midodrine, droxidopa, fludrocortisone, pyridostigmine, octreotide norerythropoietin. She was then transferred to the University of Toledo Medical Center where she was thought to have severe postural tachycardia syndrome, most likely due to an auto-immune process.
She thereafter underwent therapy with intravenous gammaglobulin. Within a week, for the first time in over a month, she was able to sit up in a chair without losing consciousness. Intravenous gammaglobulin therapy was continued on a biweekly basis while at the same time she underwent inpatient physical therapy and rehabilitation.
By the time of discharge, she was able to walk for the first time in months without losing consciousness.
This case illustrates the potential autoimmune basis of some patients suffering from syncope due to Postural Tachycardia Syndrome, as well as the potential role for immune modulating therapy as a treatment modality.