The most common symptoms of coronavirus disease 19 (COVID-19) from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include fever, cough, sore throat, and fatigue. As case numbers grow, neurological symptoms have been reported with increasing frequency, including those of autonomic dysfunction [1]. Most neurological reports detail symptoms in hospitalized patients during the para-infectious period; thus, understanding of longer-term, post-infectious sequalae is limited. We report the case of a patient who developed postural tachycardia syndrome (POTS) several months after confirmed SARS-CoV-2 infection.

In early March of 2020, a 26-year-old emergency department nurse in Orange County, California developed a mild cough and an itchy throat. She woke the next day with palpitations, fatigue, and mild shortness of breath. On day 3 she presented to urgent care and had a nasopharyngeal swab which returned negative for SARS-CoV-2 PCR. On day 7 she woke up with palpitations, shortness of breath, and anorexia. She noted that her resting seated HR was 110 bpm and would increase to 190 bpm after walking up a flight of stairs. Her cough worsened and she developed burning chest pains on inhalation. She presented to the emergency department for evaluation, where her temperature was 100.4℉ and her SaO2 98%. A chest CT was performed and demonstrated moderate bronchitis with right lower lobe atelectasis. Her SARS-CoV nasopharyngeal swab was repeated and returned positive. IgG and IgM antibodies to the SARS-CoV-2 spike receptor binding domain (RBD) also returned positive. She was given IV fluids, a 5-day prescription of azithromycin, and discharged home.