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We hypothesized that her syndrome was due to autoimmunity against muscarinic acetylcholine receptors, blocking their activation. Using an indirect enzyme\u2010linked immunosorbent assay for all 5 muscarinic receptors (M<jats:sub>1<\/jats:sub>\u2013M<jats:sub>5<\/jats:sub>), we identified in the patient's serum antibodies that selectively bound to M<jats:sub>3<\/jats:sub> receptors. In vitro functional studies confirmed that these autoantibodies selectively blocked M<jats:sub>3<\/jats:sub> receptor activation. Thus, autoantibodies against M<jats:sub>3<\/jats:sub> acetylcholine receptors cause acute postganglionic cholinergic dysautonomia. 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