Abstract
Coronavirus disease 2019 (COVID-19) is a significant risk factor for autonomic dysfunction, with approximately 20% of COVID-19-infected children suffering from post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC). The autonomic nervous system regulates functions like blood pressure and heart rate, and the disruption of the system can lead to issues such as postural orthostatic tachycardia syndrome (POTS) and orthostatic dysregulation (OD). Individuals with autonomic dysfunction may have a heightened risk of sudden death during diving activities. We report the case of a patient who drowned after diving in a bathtub following COVID-19 infection. The patient exhibited findings consistent with POTS during the head-up tilt test (HUTT), suggesting the influence of autonomic dysregulation. A healthy 9-year-old boy had a mild COVID-19 infection. He recovered but experienced difficulty getting out of bed. Nevertheless, his daily activities remained largely unaffected. On the 11th day post-infection, he lost consciousness while diving in a bathtub and was quickly rescued by his father. Initial assessments revealed mild aspiration pneumonia and OD. On day 20, a HUTT revealed tachycardia, confirming POTS. Bathing alone was prohibited, and a reevaluation three months later indicated subjective symptom improvement, with no evidence of POTS during HUTT. This case highlights the potential association between mild autonomic dysfunction post-COVID-19 and increased drowning risk during cardiovascular-intensive activities like diving. Even when subjective symptoms are minimal, using tests such as HUTT to assess potential underlying autonomic dysfunction can help prevent secondary accidents.