SERPINA1 and postural orthostatic tachycardia syndrome: We discussed with the patient and family that Lyme disease, clinical babesiosis, probable bartonellosis, postural orthostatic tachycardia syndrome (POTS)/dysautonomia, phase 2 adrenal dysfunction with metabolic syndrome/reactive hypoglycemia, alpha-1 antitrypsin deficiency, mold, and heavy metal toxicity, along with chronic variable immune deficiency (CVID), were the primary diagnoses based on her record review, laboratory work, and physical examination that accounted for her chronic persistent symptoms.