Category: Case Study

Familial chronic fatigue

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/

 

Detection of RNA sequences in cultures of a stealth virus isolated from the cerebrospinal fluid of a health care worker with chronic fatigue syndrome. Case report

Abstract:

A cytopathic stealth virus was cultured from the cerebrospinal fluid of a nurse with chronic fatigue syndrome. Reverse transcriptase-polymerase chain reaction (RT-PCR) performed on the patient’s culture yielded positive results with primer sets based on sequences of a previously isolated African green monkey simian-cytomegalovirus-derived stealth virus. The same primer sets did not yield PCR products when tested directly on DNA extracted from the cultures. The findings lend support to the possibility of replicative RNA forms of certain stealth viruses and have important implications concerning the choice of therapy in this type of patient.

 

Source: Martin WJ. Detection of RNA sequences in cultures of a stealth virus isolated from the cerebrospinal fluid of a health care worker with chronic fatigue syndrome. Case report. Pathobiology. 1997;65(1):57-60. http://www.ncbi.nlm.nih.gov/pubmed/9200191

 

N of 1 trials. Managing patients with chronic fatigue syndrome: two case reports

Abstract:

Chronic fatigue syndrome is a heterogeneous condition with as proves effective treatment. I present two case reports in which N of 1 trials helped me make management decisions. High-dose vitamin B12 injections were ineffective in one case; nimodipine was very effective in the other case.

 

Source: Wiebe E. N of 1 trials. Managing patients with chronic fatigue syndrome: two case reports. Can Fam Physician. 1996 Nov;42:2214-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2146911/ (Full article)

 

Chronic fatigue, arthralgia, and malaise

A 25 year old female veterinary nurse presented with a six year history of general malaise and severe fatigue. Associated with this she described frequent (monthly) episodes of polyarthralgia affecting all joints but with a predilection for the small joints of the hands and the wrists. When present this was accompanied by mild morning stiffness. In addition she experienced colicky abdominal pain, sometimes with diarrhoea, occasionally with blood mixed with her faeces. Other complaints consisted of low back pain, sore gritty eyes, and an inability to perform any physical exercise at the time of these symptoms. Her symptoms had been remarkably consistent, with no recent change to their pattern.

Six years ago she had been on a working holiday at a veterinary practice situated in New York state, USA. After eating a dish made with “blue fish” she had immediately developed severe nausea, vomiting, and malaise. Although all her acute symptoms resolved, her other symptoms started on return to the United Kingdom. She was investigated twice, at different hospitals, before being referred to this department. It had been found that her symptoms were helped by treatment with 30 mg prednisolone daily for the severe episodes and a maintenance dose of 5 mg daily. Severe episodes were occurring three to four times a year. Non-steroidal anti-inflammatory drugs, sulphasalazine, and other treatments of inflammatory bowel disease had not helped her symptoms. On all occasions the examination and investigations had been reported as normal including markers of inflammation, connective tissue disease, and radiological and histological gastrointestinal studies. No blood had been seen in her faeces. No diagnosis was made other than a seronegative arthralgia.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010225/pdf/annrheumd00353-0014.pdf

 

Source: Gompels MM, Spickett GP. Chronic fatigue, arthralgia, and malaise. Ann Rheum Dis. 1996 Aug;55(8):502-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010225/

 

Management of chronic fatigue syndrome: case study

Abstract:

1. Chronic fatigue syndrome (CFS) is a complex disorder marked by incapacitating fatigue of uncertain etiology which has resulted in a least a 50% reduction in activity and is of at least 6 months’ duration. 2. Definitive diagnosis can be very challenging. Because no markers objectively identify the presence of CFS, diagnosis depends heavily on the presence of subjective complaints. 3. The current philosophy of CFS management is to use a multidisciplinary approach incorporating these rehabilitation goals: restore a sense of self efficacy and control; gradually increase physical activity; and decrease the restrictions imposed by CFS.

 

Source: Dyck D, Allen S, Barron J, Marchi J, Price BA, Spavor L, Tateishi S. Management of chronic fatigue syndrome: case study. AAOHN J. 1996 Feb;44(2):85-92. http://www.ncbi.nlm.nih.gov/pubmed/8694980

 

Use of anti HHV-6 transfer factor for the treatment of two patients with chronic fatigue syndrome (CFS). Two case reports

Abstract:

Specific Human Herpes virus-6 (HHV-6) transfer factor (TF) preparation, administered to two chronic fatigue syndrome patients, inhibited the HHV-6 infection. Prior to treatment, both patients exhibited an activated HHV-6 infection. TF treatment significantly improved the clinical manifestations of CFS in one patient who resumed normal duties within weeks, whereas no clinical improvement was observed in the second patient. It is concluded that HHV-6 specific TF may be of significant value in controlling HHV-6 infection and related illnesses.

 

Source: Ablashi DV, Levine PH, De Vinci C, Whitman JE Jr, Pizza G, Viza D. Use of anti HHV-6 transfer factor for the treatment of two patients with chronic fatigue syndrome (CFS). Two case reports. Biotherapy. 1996;9(1-3):81-6. http://www.ncbi.nlm.nih.gov/pubmed/8993763

 

EEG biofeedback as a treatment for chronic fatigue syndrome: a controlled case report

Abstract:

EEG neurofeedback has been identified as a potential diagnostic and treatment protocol with chronic fatigue syndrome (CFS) symptoms. In the present case study, the authors applied an EEG neurofeedback biofeedback paradigm as a treatment modality with a CFS patient. Baseline data were acquired using the Wechsler Adult Intelligence Scale-Revised and qualitative and subjective ratings of cognitive improvement. Test results and clinical findings revealed improvements in the patient’s cognitive abilities, functional skill level, and quality of life. The patient showed significant differences in pre- and posttest levels on the Wechsler scale.

 

Source: James LC, Folen RA. EEG biofeedback as a treatment for chronic fatigue syndrome: a controlled case report. Behav Med. 1996 Summer;22(2):77-81. http://www.ncbi.nlm.nih.gov/pubmed/8879459

 

Possible correlation between Borna disease virus infection and Japanese patients with chronic fatigue syndrome

Abstract:

Borna disease virus (BDV) is a neurotropic, as yet unclassified, non-segmented, negative-sense, single-strand RNA virus. Natural infection with this virus has been reported to occur in horses and sheep. In addition, antibodies to BDV in plasma or BDV RNA in peripheral blood mononuclear cells (PBMCs) were also found in patients with neuropsychiatric diseases. We describe here the possible link between the patients with chronic fatigue syndrome (CFS) and infection with BDV.

 

Source: Kitani T, Kuratsune H, Fuke I, Nakamura Y, Nakaya T, Asahi S, Tobiume M, Yamaguti K, Machii T, Inagi R, Yamanishi K, Ikuta K. Possible correlation between Borna disease virus infection and Japanese patients with chronic fatigue syndrome. Microbiol Immunol. 1996;40(6):459-62. http://www.ncbi.nlm.nih.gov/pubmed/8839433

 

Epstein-Barr virus infection associated with interstitial nephritis and chronic fatigue

Abstract:

Severe renal disease in the setting of Epstein-Barr virus (EBV) infection is exceedingly rare. We report here the case of a 22-year-old man with acute EBV infection associated with severe interstitial nephritis. The patient developed chronic fatigue and chronic renal failure with a serological profile typical of primary EBV infection. Clinical improvement with anti-EBNA seroconversion occurred after acyclovir therapy. Our patient illustrates that chronic fatigue with major organ dysfunction and a serological profile of primary infection can be seen in chronic EBV infection. In such a case, acyclovir may prove beneficial.

 

Source: López-Navidad A, Domingo P, López-Talavera JC, Rabella N, Verger G. Epstein-Barr virus infection associated with interstitial nephritis and chronic fatigue. Scand J Infect Dis. 1996;28(2):185-7. http://www.ncbi.nlm.nih.gov/pubmed/8792488

 

A case of chronic fatigue syndrome who showed a beneficial effect by intravenous administration of magnesium sulphate

Abstract:

We have treated a case of chronic fatigue syndrome with atopic diathesis was had suffered general malaise, low grade fever, swelling of the lymph nodes, myalgias and arthralgias for a long time.

A 29-year-old female, who had been treated for atopic dermatitis for 5 years, complained of general malaise in May 1990. She was admitted to the nearest hospital in December 1990 because of low grade fever, swelling of the lymph nodes and an elevation of antinuclear antibody (2520x). She was transferred to our hospital in May 1991.

A diagnosis of collagen disease was not compatible with her condition. In addition to general malaise, fever and lymph node swelling, headache, myalgias, muscle weakness, arthralgias and insomnia were observed, and a diagnosis of chronic fatigue syndrome was made based on the working case definition proposed by Holmes et al.

Although eosinophilia, a high serum level of IgE, and elevation of RAST scores, low NK and ADCC activity, and a reduced level of NK cells in the peripheral blood were detected, serum antibodies to a number of viruses were in the normal range.

Treatments with non-steroid anti-inflammatory drugs, minor tranquilizers and antidepressant drugs were not effective at all. An administration of magnesium sulphate was intravenously performed once a week in order to improve her condition, especially severe general malaise. After about 6-week’s administration of magnesium sulphate, she noticed reduced easy fatigability and an improvement in her impaired daily activities. Finally she was able to leave the hospital in January 1992.(ABSTRACT TRUNCATED AT 250 WORDS)

 

Source: Takahashi H, Imai K, Katanuma A, Sugaya T, Hisano K, Motoya S, Aoki S, Sugiyama T, Yachi. A case of chronic fatigue syndrome who showed a beneficial effect by intravenous administration of magnesium sulphate. Arerugi. 1992 Nov;41(11):1605-10. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/1492795