Acute sympathotonic orthostatic hypotension with recovery

We describe a 30 year-old female who presented with severe orthostatic hypotension despite appropriate compensatory tachycardia on standing, following a viral infection. Clinical assessment and laboratory evaluation failed to detect other causes of her illness besides sympathotonic orthostatic hypotension. She responded to fludrocortisone and recovered completely after 3 months. We postulate that her acute reversible illness was due to a post-viral immunological response selectively affecting the alpha adrenergic receptors subserving the post-ganglionic sympathetic vasomotor fibres.