Category: Case Study

How I manage chronic fatigue syndrome

About 12 years ago, I was asked to do a domicillary visit to see a 10 year old girl who in the spring had taken her secondary school entrance examination; caught a heavy cold with a persistent sore throat, which was taking a long time to clear; had a perpetual headache; dizziness on standing; extreme tiredness, which became worse if she tried to do anything; paraesthesia of the hands and feet intermittently; and disturbed sleep. Her general practitioner suggested postural hypotension, but I could find little abnormal except for some unsteadiness when she tried to walk. Routine haematological and biochemical tests were normal, as was computed tomography of her head. The physiotherapist that I referred her to reported that their attempts to mobilise her were actually making her worse, and wondered if she had a neuromuscular disease.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf

 

Source: Franklin A. How I manage chronic fatigue syndrome. Arch Dis Child. 1998 Oct;79(4):375-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf (Full article)

 

The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome

Abstract:

An elite ultra-endurance athlete, who had previously undergone physiological and performance testing, developed chronic fatigue syndrome (CFS).

An incremental cycling exercise test conducted while he was suffering from CFS indicated decreases in maximum workload achieved (Wmax; -11.3%), the maximum oxygen uptake (VO2max; -12.5%), and the anaerobic threshold (AT; -14.3%) compared to pre-CFS data.

A third test conducted after the athlete had shown indications of significant improvement in his clinical condition revealed further decreases in Wmax (-7.9%), VO2max (-10.2%) and AT (-8.3%).

These data, along with submaximal exercise data and muscle biopsy electron microscopic analyses, suggest that the performance decrements were the result of detraining, rather than an impairment of aerobic metabolism due to CFS per se. These data may be indicative of central, possibly neurological, factors influencing fatigue perception in CFS sufferers.

 

Source: Rowbottom DG, Keast D, Green S, Kakulas B, Morton AR. The case history of an elite ultra-endurance cyclist who developed chronic fatigue syndrome. Med Sci Sports Exerc. 1998 Sep;30(9):1345-8. http://www.ncbi.nlm.nih.gov/pubmed/9741601

 

A 56-Year-Old Woman With Chronic Fatigue Syndrome, 1 Year Later

In June 1997, at the Medicine Grand Rounds, Dr Anthony Komaroff discussed Ms H, an educator unable to work because of debilitating symptoms associated with a 2-year history of chronic fatigue. Her ailment, which began shortly after a flu-like illness, was marked primarily by weakness, fatigue, chronic insomnia, and depression that she felt was in response to her symptoms. In recent years she had felt somewhat less depressed, and wondered also if the disease might be slowly diminishing in its severity.

You can read the rest of this article here: http://jama.jamanetwork.com/article.aspx?articleid=187800

 

Source: Thomas L. Delbanco, MD; Jennifer Daley, MD; Erin E. Hartman, MS. A 56-Year-Old Woman With Chronic Fatigue Syndrome, 1 Year Later. JAMA. 1998;280(4):372. doi:10.1001/jama.280.4.372. http://jama.jamanetwork.com/article.aspx?articleid=187800

Hypnosis in chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is characterized by medically unexplained chronic and disabling physical and mental fatigue. There is growing evidence of organic abnormalities 2 but the involvement of psychological factors in its aetiology and chronicity should also be recognized 3.

One approach to the complaint assumes it is post-viral in origin with psychiatric and social antecedents 4. The sufferer attributes the fatigue and myalgia which persist beyond an initial infectious episode to a continuing viral infection, and interprets them as indicating that activity hinders recovery. A vicious circle is established in which avoidance of activity leads to deconditioning, depression and the perpetuation of symptoms. This view has encouraged the use of cognitive behaviour therapy to increase exercise in graded stages by inducing a more positive attitude towards activity an approach that has met with encouraging results5. Nevertheless, it would seem wrong to attribute CFS entirely to inactivity and sufferers’ illness attributions, if only because there are sufferers who are moderately active and working part-time. Such a model also has difficulty explaining why the symptoms fluctuate within a day, or over longer periods. Furthermore, many sufferers strongly believe that exercise, even in a carefully controlled schedule, will make them feel ill and prolong the complaint. They refuse to contemplate any such therapy 6.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296740/pdf/jrsocmed00033-0038.pdf

 

Source: Gregg VH. Hypnosis in chronic fatigue syndrome. J R Soc Med. 1997 Dec;90(12):682-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296740/

 

Chronic fatigue syndrome: relationships of self-ratings and actigraphy

Abstract:

Chronic Fatigue Syndrome is a baffling disease potentially affecting millions of Americans. Self-rating scales were developed to assess this condition but have yet to be validated with objective measures of activity. The present study of a 45-yr.-old man evaluated the relationships between scores on self-rating scales used to measure Chronic Fatigue Syndrome and actigraphy. Measured activity was related to predictors of fatigue but not to fatigue. The implications of these findings are discussed.

 

Source: Jason LA, Tryon WW, Frankenberry E, King C. Chronic fatigue syndrome: relationships of self-ratings and actigraphy. Psychol Rep. 1997 Dec;81(3 Pt 2):1223-6. http://www.ncbi.nlm.nih.gov/pubmed/9461755

 

Chronic fatigue–‘tired with 23 i’s’

 

Abstract:

Two patients, a woman aged 32 years and a man aged 49, presented with severe chronic fatigue. The woman had chronic fatigue syndrome; she recovered slowly. The man suffered from a pituitary adenoma producing follicle stimulating hormone; he recovered after transsphenoidal hypophysectomy.

In patients with chronic fatigue, the history and a thorough physical examination to exclude underlying illness are very important; secondary symptom criteria must not be overemphasized (as is the case with the Holmes and Fukuda criteria), chronic fatigue syndrome should not be diagnosed if the condition has a shorter duration than 6 months, but it should be diagnosed if the clinical picture is compatible.

The prognosis is not poor: in patients with a median disease duration of 4.5 years, 20% show significant improvement over an 18-month period.

Comment in:

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

 

Source: van der Meer JW, Elving LD. Chronic fatigue–‘tired with 23 i’s’. Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1505-7. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543734

 

Chronic parvovirus B19 infection resulting in chronic fatigue syndrome: case history and review

Abstract:

The spectrum of disease caused by parvovirus B19 has been expanding in recent years because of improved and more sensitive methods of detection. There is evidence to suggest that chronic infection occurs in patients who are not detectably immunosuppressed.

We report the case of a young woman with recurrent fever and a syndrome indistinguishable from chronic fatigue syndrome. After extensive investigation, we found persistent parvovirus B19 viremia, which was detectable by polymerase chain reaction (PCR) despite the presence of IgM and IgG antibodies to parvovirus B19.

Testing of samples from this patient suggested that in some low viremic states parvovirus B19 DNA is detectable by nested PCR in plasma but not in serum. The patient’s fever resolved with the administration of intravenous immunoglobulin.

 

Source: Jacobson SK, Daly JS, Thorne GM, McIntosh K. Chronic parvovirus B19 infection resulting in chronic fatigue syndrome: case history and review. Clin Infect Dis. 1997 Jun;24(6):1048-51. http://cid.oxfordjournals.org/content/24/6/1048.long (Full article)

 

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)