(1) Introduction: Symptom spectrum can be of great diversity and heterogeneity in
mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (
MELAS) patients in clinical practice. Here, we report a case of
MELAS presenting asymptomatic refractory
hypotension with m.3243 A>G mutation. (2) Case representation: A 51-year-old male patient presented with a
headache,
vertigo, and difficulty in expression and understanding. The magnetic resonance imaging of the brain revealed an
acute stroke-like lesion involving the left temporoparietal lobe. A definitive diagnosis of
MELAS was given after the genetic test identified the chrM-3243 A>G mutation. The patient suffered recurrent
stroke-like episodes in the 1-year follow-up. Notably, refractory
hypotension was observed during hospitalizations, and no significant improvement in blood pressure was found after continuous use of vasopressor drugs and fluid infusion
therapy. (3) Conclusions: We report a case of refractory
hypotension which was unresponsive to fluid infusion
therapy found in a patient with
MELAS. Our case suggests that comprehensive management should be paid attention to during treatment. A further study on the pathological mechanism of the multisystem symptoms in
MELAS would be beneficial to the treatment of patients.