Objectives Postural orthostatic tachycardia syndrome (POTS) is a chronic disorder of the autonomic nervous system that is associated with orthostatic intolerance (OI) and gastrointestinal (GI) symptoms. We aimed to determine if a gluten-free diet (GFD) may be an effective treatment in patients with POTS. Methods Patients with confirmed POTS and without celiac disease who followed GFD for 4 weeks retrospectively completed pre- and post- GFD COMPASS-31 questionnaires. Paired-samples t-tests were conducted to compare COMPASS-31 scores before and after adopting GFD. Results All 20 patients (all females, age 16–62 years (mean age 33)), had POTS symptoms for 1–30 years (mean 10.8, SD = 10.23 years). Eleven patients had co-morbid mast cell activation syndrome, and 8 had hypermobile Ehlers-Danlos syndrome. Pre-GFD COMPASS-31 scores (mean 57.8) were significantly higher than post-GFD scores (mean 38.2, t(19) = -8.92, p < 0.00001), with the largest improvement noted in the OI (p < 0.00001), vasomotor, (p = 0.0034), and GI (p = 0.0004) domains and with a mean reduction in total COMPASS-31 score by 33.9% after implementing GFD. All patients reported improved symptoms on GFD with mean self-assessed improvement of 50.5% (range 10-99%). Discussion GFD may be effective in reducing the symptom burden in patients with POTS, particularly in the OI, vasomotor, and GI symptom domains. Large prospective studies are necessary to confirm whether GFD is an effective long-term treatment option for patients.
Immunodeficiency-associated lymphoproliferative disorders (IA-LPDs) are malignancies that occur in the setting of solid organ transplant, human immunodeficiency virus (HIV) infection, primary immune disorders, or iatrogenic causes. 1 Most iatrogenic IA-LPDs occur secondary to treatment with immunosuppressive therapy. 1 Mycophenolate mofetil (MMF), an antimetabolite immunosuppressant, is frequently used in the treatment of autoimmune conditions, including myasthenia gravis (MG). In the setting of MG, only one case of iatrogenic central nervous system (CNS) IA-LPD has been reported after long-term MMF use. 2 Here, we report a second case.
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