A Case of Post-Malarial Postural Orthostatic Tachycardia Syndrome in a Young Woman of South Asian Origin

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a chronic and debilitating dysautonomic disorder characterized by impairments in autonomic control of cardiovascular, gastrointestinal, and thermoregulation functions, resulting in various symptoms of orthostatic intolerance. While POTS is increasingly being diagnosed as post-COVID sequelae and complications, it’s rarely being reported if caused by non-viral infections and other clinical conditions. This case study reports a 30-year-long medical history of a patient who developed POTS at the age of 21 after about 4-weeks following a complete recovery from malignant malaria when she was a first-year medical student. She was initially presented with tachycardia, dizziness, presyncope, several episodes of syncope, and dysautonomic symptoms and was diagnosed with POTS only four years later by a tilt table test. This is a rare and probably the first reported case of post-malarial POTS, although symptoms associated with severe orthostatic hypotension, such as tachycardia and insufficient peripheral vasoconstriction, that are very similar to the symptoms of POTS, have been previously described in cases with acute malignant malaria. The patient made a remarkable recovery from POTS as she responded well to pharmacotherapy, primarily beta-blockers, along with lifestyle modifications. However, mild dysautonomic symptoms such as lack of thermoregulation and decreased perspiration have persisted throughout, and the patient has managed to cope with these symptoms and could function well in her daily life. Based on this case study, we suggest that the non-viral etiology of POTS, particularly the post-malarial cases, should be studied in detail to further understand the pathophysiology and management of the disorder.