Immune-Mediated Autonomic Neuropathies following Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia

Table 1

Table summarizing results of clinical/laboratory testing, treatment response, and outcomes in the two cases.

Test	Case  1	Case  2
Autonomic reflex screen	(i) Moderate cardiovagal, widespread postganglionic sudomotor and severe adrenergic impairment on this study.; (ii) Decreased heart rate responses to deep breathing and Valsalva maneuver.; (iii) QSWEAT responses reduced at all sites except the forearm.	(i) Significant adrenergic failure with mild cardiovagal and probable distal postganglionic sudomotor impairment.; (ii) Heart rate responses to deep breathing and Valsalva maneuver were reduced.; (iii) The quantitative sudomotor axon reflex tests were normal for all sites except marked reduction at foot.
Antibody tests (all were undetectable); tested in addition for case  2	ANNA-1, striated muscle, acetylcholine receptor (AChR muscle binding and neuronal ganglionic), neuronal K+ channel, GAD-65, and N- and P/Q type calcium channel, ganglioside, , Purkinje Cell .
Treatment	IVIG 0.4 gm/kg for 5 days.	IVIG at 0.4 gm/kg for 5 days, daily plasmapheresis, prednisone at 1 mg/kg.
Response	Significant symptomatic improvement. Posttreatment autonomic reflex testing not performed.	Significant symptomatic improvement in two weeks.; Posttreatment autonomic reflex screen showed normal heart rate responses to deep breathing and Valsalva maneuver and normal quantitative sudomotor axon reflex tests at all sites except the foot.