Persistent Antiphospholipid Antibodies, Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Post-COVID Syndrome: 1 Year On

  • Jill Schofield University of Colorado School of Medicine, Aurora, Colorado, USA

Keywords

Long-haul COVID-19, antiphospholipid antibodies, postural orthostatic tachycardia syndrome, mast cell activation syndrome, post-COVID syndrome

Abstract

This is the first case report of a patient with post-COVID-19 postural orthostatic tachycardia syndrome (POTS) with multiple persistent antiphospholipid antibody (aPL)-positivity more than a year after illness onset who also meets Global Consensus-2 criteria for mast cell activation syndrome (MCAS), suggesting pathological activation of the acquired and innate immune systems by SARS-CoV-2. While the patient continues to meet criteria for POTS 1 year on, her functional ability has improved significantly with therapy directed at MCAS, POTS and aPL-positivity.

 

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References

  • Carfi A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603–605.
  • Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, Sánchez-Larsen Á, Layos-Romero A, García-García J, et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology 2020;95(8):e1060–e1070. doi: 10.1212/WNL.0000000000009937
  • Miglis MG, Prieto T, Shaik R, Muppidi S, Sinn DI, Jaradeh S. A case report of postural tachycardia syndrome after COVID-19. Clin Auton Res 2020;30(5):449–451. doi: 10.1007/s10286-020-00727-9
  • Afrin LB, Weinstock LB, Molderings GJ. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis 2020;100:327–332. doi: 10.1016/j.ijid.2020.09.016
  • Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond) 2020;21(1):e63–e67. doi: 10.7861/clinmed.2020-0896
  • Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015;12(6):e41–e63.
  • Schofield JR. Autoimmune autonomic neuropathy–in its many guises–as the initial manifestation of the antiphospholipid syndrome. Immunol Res 2017;65:532–542.
  • Devreese KMJ, Linskens EA, Benoit D, Peperstraete H. Antiphospholipid antibodies in patients with COVID-19: a relevant observation? J Thromb Haemost 2020;18(9):2191–2201.
  • Xiao M, Zhang Y, Zhang S, Qin X, Xia P, Cao W, et al. Antiphospholipid antibodies in critically ill patients with COVID-19. Arthritis Rheumatol 2020;72(12):1998–2004.
  • Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.
  • Afrin LB, Ackerley MB, Bluestein LS, Brewer JH, Brook JB, Buchanan AD, et al. Diagnosis of mast cell activation syndrome: a global “consensus-2”. Diagnosis 2020 Apr 22;dx-2020-0005. doi: 10.1515/dx-2020-0005. Online ahead of print.
  • Schofield JR, Hughes HN, Birlea M, Hassell KL. A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: a retrospective study of 75 patients. Lupus 2021 Jan 5;961203320983913. doi: 10.1177/0961203320983913. Online ahead of print.
  • Schofield JR, Chemali K. The efficacy and safety of intravenous immunoglobulin therapy in autoimmune dysautonomias. Am J Ther 2019;26(5):570–582.
  • Published: 2021-03-22

    Issue: Vol 8 No 3 (view)

    Section: Articles

    How to cite:
    1.
    Schofield J. Persistent Antiphospholipid Antibodies, Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Post-COVID Syndrome: 1 Year On. EJCRIM 2021;8 doi:10.12890/2021_002378.