A 41-year-old man with polyarthritis and severe autonomic neuropathy

Case report

(1676) Views  (680) Full article downloads

Authors: Matthew E Bourcier, Aaron I Vinik

Published Date September 2008 Volume 2008:4(4) Pages 837 - 842

DOI: http://dx.doi.org/10.2147/TCRM.S2712

Matthew E Bourcier, Aaron I Vinik

Eastern Virginia Medical School, Norfolk, VA, USA

Abstract: Orthostasis due to autonomic neuropathy can cause severe debilitation and prove refractory to treatment. This report describes a case of severe sympathetic and parasympathetic autonomic dysfunction as a consequence of acetylcholine receptor antibodies and Sjogren’s syndrome. Symptomatic management, plasma fluid expanders, and IVIG therapy failed to offer a salutary response to the condition. Etanercept therapy provided improvement of the orthostasis and autonomic function measured as high and low frequency respiratory effects on heart rate variability as well as enhancement of skin blood flow using Laser Doppler. It would be of considerable interest to determine the effectiveness of etanercept in other autoimmune neuropathies.

Keywords: autonomic neuropathy, etanercept, IntraEpidermal Nerve Fibers (IENF), acetylcholine receptor antibodies, laser doppler skin blood flow, orthostasis