Unusual cause of partially reversible severe cardiovascular autonomic failure

We report an unusual case of partially reversible severe cardiovascular autonomic system failure in a patient with double primary malignancies. The patient presented with severe orthostatic hypotension preceding the detection of lymphoma and lung cancer. The patient had autonomic failure on presentation. One year after surgery and chemotherapy, there was a gradual improvement in both symptoms and autonomic function simultaneously. We conclude that paraneoplastic severe autonomic failure can be reversible.