A 53-year-old woman presented to her general practitioner with a long history of profound lethargy associated with insomnia and arthralgia mainly affecting her knees. The patient dated her symptoms to a ‘flu-like’ illness six months previously. Medical history was of hypertension treated with an angiotensin-converting enzyme inhibitor and thiazide diuretic. She had also been taking oestrogen replacement since the menopause two years earlier. She had been a blood donor until 13 years previously, donating a total of 24 units of blood. She drank four units of alcohol per week but did not smoke. Physical examination was normal. Initial investigations performed were full blood count, urea and electrolytes, liver function tests, thyroid function tests, random glucose, cholesterol, calcium and urate. All were normal. Rheumatoid factor was negative and viral serology showed a raised IgG antibody titre to Epstein Barr virus, indicative of a past infection. XRays of the knee joints were normal.
A diagnosis of chronic fatigue syndrome was made. Over the following months her symptoms impaired her ability to work, shop and perform household tasks. Further medical consultations revealed no new features or abnormal tests and she took early retirement on the grounds of poor health.
Two years after her initial presentation, her brother, who had also been suffering from longstanding fatigue, was diagnosed as having liver disease.
You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2431297/pdf/postmedj00149-0057.pdf
Source: George DK, Evans RM, Gunn IR. Familial chronic fatigue. Postgrad Med J. 1997 May;73(859):311-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2431297/