Category: Case Study

The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study

Abstract:

PROBLEM: Up to one in three young people with chronic fatigue syndrome (CFS/ME) also has depressive symptoms. It is not known how best to treat young people with this comorbidity.

METHOD: This case report seeks to describe and discuss the use of a cognitive behavioral approach for depression and low self-esteem in a 16-year-old girl with CFS/ME.

FINDINGS/CONCLUSION: Therapy was effective in remediating the young person’s mood difficulties, but appeared to exacerbate their CFS/ME symptoms. Therefore, it is crucial that CFS/ME and mood treatments are designed and trialed to ensure a complementary approach. Good communication and joint working between involved professionals is also important, and ideally, treatments for mood and for CFS/ME would be provided by the same team to facilitate this.

© 2015 Wiley Periodicals, Inc.

 

Source: Loades M. The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study. J Child Adolesc Psychiatr Nurs. 2015 Nov;28(4):165-74. doi: 10.1111/jcap.12125. Epub 2015 Oct 16. https://www.ncbi.nlm.nih.gov/pubmed/26470755

 

Oral Colostrum Macrophage-activating Factor for Serious Infection and Chronic Fatigue Syndrome: Three Case Reports

Abstract:

BACKGROUND: Gc protein-derived macrophage-activating factor (GcMAF) immunotherapy has been steadily advancing over the last two decades. Oral colostrum macrophage-activating factor (MAF) produced from bovine colostrum has shown high macrophage phagocytic activity. GcMAF-based immunotherapy has a wide application for use in treating many diseases via macrophage activation or for use as supportive therapy.

RESULTS: Three case studies demonstrate that oral colostrum MAF can be used for serious infection and chronic fatigue syndrome (CFS) without adverse effects.

CONCLUSION: We demonstrate that colostrum MAF shows promising clinical results in patients with infectious diseases and for symptoms of fatigue, which is common in many chronic diseases.

Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

 

Source: Inui T, Kubo K, Kuchiike D, Uto Y, Nishikata T, Sakamoto N, Mette M. Oral Colostrum Macrophage-activating Factor for Serious Infection and Chronic Fatigue Syndrome: Three Case Reports. Anticancer Res. 2015 Aug;35(8):4545-9. https://www.ncbi.nlm.nih.gov/pubmed/26168499

 

Paradoxical response to intravenous immunoglobulin in a case of Parvovirus B19-associated chronic fatigue syndrome

Abstract:

We describe a case of chronic fatigue syndrome (CFS) associated to Parvovirus B19 infection where administration of intravenous immunoglobulins (IVIG), previously reported as effective, induced a paradoxical clinical response and increased viral replication. The indication of IVIG administration in the treatment of Parvovirus B19-associated CFS should be carefully reconsidered.

Copyright © 2014 Elsevier B.V. All rights reserved.

 

Source: Attard L, Bonvicini F, Gelsomino F, Manfredi R, Cascavilla A, Viale P, Varani S, Gallinella G. Paradoxical response to intravenous immunoglobulin in a case of Parvovirus B19-associated chronic fatigue syndrome. J Clin Virol. 2015 Jan;62:54-7. doi: 10.1016/j.jcv.2014.11.021. Epub 2014 Nov 22. https://www.ncbi.nlm.nih.gov/pubmed/25542471

 

Fibromyalgia and chronic fatigue syndrome caused by non-celiac gluten sensitivity

Dear Editor:

Sensitivity to gluten with negative celiac disease testing or non-celiac sensitivity to gluten is a recently recognized problem with clinical manifestations that are superimposed with those of fibromyalgia, chronic fatigue and irritable bowel syndrome.

We present the case of a 40-year-old woman who came to the clinic with a 7-year history of generalized pain and chronic fatigue. She had been diagnosed with fibromyalgia by several rheumatologists and complied with the 1990 American College or Rheumatology criteria. She also presented chronic fatigue syndrome criteria. She had concentration and memory problems, «foggy mind», and intermittent diarrhea. The severity of the affection led to limitation in her daily activities which limited her to bed rest in spite of several visits to specialists in rheumatology, gastroenterology and alternative medicine/homeopathy. In addition to the typical symptoms of fibromyalgia, chronic fatigue and intermittent diarrhea, she had oral ulcers, autoimmune hypothyroidism and a history of iron deficiency. She had undergone multiple studies with normal findings, including anti-transglutaminase IgA antibodies to rule out celiac disease.

We suspected sensitivity to gluten and more studies were performed. Laboratory studies showed iron deficiency and low vitamin D levels. On a screening test for anti-transglutaminase and anti-deaminated gliadin peptide antibodies, both IgG and IgA were negative. HLA typing showed the presence of DQ2 (DQA1*05 DQB1*02). Gastroscopy showed small erythematous lesions on the duodenal bulb. Duodenal biopsies showed normal villi structure and lymphocytic duodenitis with apical redistribution, 28 CD3 lymphocytes for every 100 enterocytes (stage I Marsh lesions). Urease testing for Helicobacter pylori was positive. Celiac disease was ruled out due to the absence of specific antibodies or intestinal villi atrophy, though we still suspected sensitivity to gluten. A gluten-free diet was recommended without treating the infection by Helicobacter pylori.

You can read the rest of this letter here: http://www.reumatologiaclinica.org/en/fibromyalgia-chronic-fatigue-syndrome-caused/articulo/S2173574314001403/

Comment in

 

Source: Isasi C, Tejerina E, Fernandez-Puga N, Serrano-Vela JI. Fibromyalgia and chronic fatigue syndrome caused by non-celiac gluten sensitivity. Reumatol Clin. 2015 Jan-Feb;11(1):56-7. doi: 10.1016/j.reuma.2014.06.005. Epub 2014 Jul 19. [Article in English, Spanish] http://www.reumatologiaclinica.org/es/linkresolver/fibromialgia-fatiga-cronica-causada-por/S1699258X14001326/ (Full article)

α-1 antitrypsin and chronic fatigue syndrome: a case study from pathophysiology to clinical practice

Abstract:

SUMMARY

BACKGROUND: Several lines of evidence support the involvement of inflammatory and immunologic abnormalities in chronic fatigue syndrome (CFS). Since recent studies have shown that α-1 antitrypsin (AAT) possesses anti-inflammatory properties, the potential therapeutic effect of AAT treatment on CFS has been investigated.

CASE PRESENTATION: A 49-year-old woman diagnosed with CFS was treated with intravenous infusions of a human plasma-derived AAT concentrate (60 mg/kg body weight weekly for 8 consecutive weeks). The patient’s monocyte elastase, a regulator of inflammatory processes, was 1170 U/mg. At completion of treatment, improvement in maximal workload was observed (54.0-71.7% of predicted). Additionally, amelioration in working memory (scores: 83-94) and perceptual organization (scores: 75-83) were detected on the Wechsler Adult Intelligence Scale-III test. Monocyte elastase decreased to a normal range (<150 U/mg). Improvement in functional capacity allowed the patient to work in part-time employment.

CONCLUSION: These findings suggest a possible role for AAT in the treatment of CFS.

 

Source: Alegre J, Camprubí S, García-Quintana A. α-1 antitrypsin and chronic fatigue syndrome: a case study from pathophysiology to clinical practice.Pain Manag. 2013 Mar;3(2):119-22. doi: 10.2217/pmt.12.84. https://www.ncbi.nlm.nih.gov/pubmed/24645995

 

Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report

Abstract:

BACKGROUND: Low-grade fever is a common symptom in patients with chronic fatigue syndrome (CFS), but the mechanisms responsible for its development are poorly understood. We submit this case report that suggests that psychological stress contributes to low-grade fever in CFS.

CASE PRESENTATION: A 26-year-old female nurse with CFS was admitted to our hospital. She had been recording her axillary temperature regularly and found that it was especially high when she felt stress at work. To assess how psychological stress affects temperature and to investigate the possible mechanisms for this hyperthermia, we conducted a 60-minute stress interview and observed the changes in the following parameters: axillary temperature, fingertip temperature, systolic blood pressure, diastolic blood pressure, heart rate, plasma catecholamine levels, and serum levels of interleukin (IL)-1β and IL-6 (pyretic cytokines), tumor necrosis factor-α and IL-10 (antipyretic cytokines). The stress interview consisted of recalling and talking about stressful events. Her axillary temperature at baseline was 37.2°C, increasing to 38.2°C by the end of the interview. In contrast, her fingertip temperature decreased during the interview. Her heart rate, systolic and diastolic blood pressures, and plasma levels of noradrenaline and adrenaline increased during the interview; there were no significant changes in either pyretic or antipyretic cytokines during or after the interview.

CONCLUSIONS: A stress interview induced a 1.0°C increase in axillary temperature in a CFS patient. Negative emotion-associated sympathetic activation, rather than pyretic cytokine production, contributed to the increase in temperature induced by the stress interview. This suggests that psychological stress may contribute to the development or the exacerbation of low-grade fever in some CFS patients.

 

Source: Oka T, Kanemitsu Y, Sudo N, Hayashi H, Oka K. Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report. Biopsychosoc Med. 2013 Mar 8;7(1):7. doi: 10.1186/1751-0759-7-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599992/ (Full article)

 

A case of lyme disease requiring over 1 year to diagnose at an infectious-disease clinic

Abstract:

A 42-year-old woman presenting with years of fever and vague symptoms could not be satisfactorily diagnosed in physical examination or conventional workups. She was presumptively diagnosed with chronic fatigue syndrome and treated symptomatically. Fourteen months after the initial visit, she developed left facial palsy. Lyme disease serology was positive. Four weeks of oral amoxicillin ameliorated symptoms. Only 5 to 15 cases of Lyme disease are reported annually in Japan, mostly from the northeastern-most island of Hokkaido. It may occur anywhere in Japan, however; probably is underdiagnosed. Lyme disease may cause fevers of unknown origin. Astute clinical suspicion and appropriate workups are thus needed to diagnose this infection.

 

Source: Iwata K, Shimada T, Kawabata H. A case of lyme disease requiring over 1 year to diagnose at an infectious-disease clinic. Kansenshogaku Zasshi. 2013 Jan;87(1):44-8. [Article in Japanese] https://www.ncbi.nlm.nih.gov/pubmed/23484378

 

Improved chronic fatigue symptoms after removal of mercury in patient with increased mercury concentration in hair toxic mineral assay: a case

Abstract:

Clinical manifestations of chronic exposure to organic mercury usually have a gradual onset. As the primary target is the nervous system, chronic mercury exposure can cause symptoms such as fatigue, weakness, headache, and poor recall and concentration. In severe cases chronic exposure leads to intellectual deterioration and neurologic abnormality. Recent outbreaks of bovine spongiform encephalopathy and pathogenic avian influenza have increased fish consumption in Korea. Methyl-mercury, a type of organic mercury, is present in higher than normal ranges in the general Korean population. When we examine a patient with chronic fatigue, we assess his/her methyl-mercury concentrations in the body if environmental exposure such as excessive fish consumption is suspected. In the current case, we learned the patient had consumed many slices of raw tuna and was initially diagnosed with chronic fatigue syndrome. Therefore, we suspected that he was exposured to methyl-mercury and that the mercury concentration in his hair would be below the poisoning level identified by World Health Organization but above the normal range according to hair toxic mineral assay. Our patient’s toxic chronic fatigue symptoms improved after he was given mercury removal therapy, indicating that he was correctly diagnosed with chronic exposure to organic mercury.

 

Source: Shin SR, Han AL. Improved chronic fatigue symptoms after removal of mercury in patient with increased mercury concentration in hair toxic mineral assay: a case. Korean J Fam Med. 2012 Sep;33(5):320-5. doi: 10.4082/kjfm.2012.33.5.320. Epub 2012 Sep 27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481032/ (Full article)

 

Pervasive refusal syndrome

Abstract:

We report here on a case of severe pervasive refusal syndrome. This is of interest for three reasons. Firstly, most reported cases are adolescent girls; our case is regarding an adolescent boy. Secondly, he was successfully treated at home and thirdly, the serology showed an apparent infective pre-cursor to the illness with evidence of possible autoimmune serology. A 14-year old boy deteriorated from a picture where diagnosed CFS/ME developed into Pervasive Refusal Syndrome. This included the inability to move or speak, with closed eyes, multiple tics, facial grimacing, heightened sensitivity to noise (hyperacusis) and touch (hyperaesthesia), and inability or unwillingness to eat anything except small amounts of sloppy food. Successful rehabilitation is reported. Finally the issue of nomenclature is discussed, raising the question whether Pervasive Refusal Syndrome would be better renamed in a way that does not imply that the condition is always volitional and oppositional, as this can distract focus away from an alliance between family and clinicians.

 

Source: Wright B, Beverley D. Pervasive refusal syndrome. Clin Child Psychol Psychiatry. 2012 Apr;17(2):221-8. doi: 10.1177/1359104511403680. Epub 2011 Jul 6. https://www.ncbi.nlm.nih.gov/pubmed/21733931

 

Tired with all those supplements?

A 37 year-old patient, who had a history of chronic fatigue syndrome (CFS), was referred to the Clinical Immunology clinic by her general practitioner (GP). Her chief complaint was of severe fatigue following a viral illness 3 months previously. Concerned by her slow recovery she had sought the advice of a private health professional, who performed a series of blood tests and told her that she had insufficient levels of several vitamins and recommended a variety of supplements. In addition to sertraline prescribed by her GP, she was taking eight nutritional supplements. Her weight was stable and she had no history of cough, night sweats, lymphadenopathy, abdominal pain, joint pain, skin rashes or change in bowel habit. Physical examination was unremarkable.

A worsening of her CFS was considered the likely reason for her increased fatigue, but a range of blood tests were requested to exclude other causes (Table 1). These showed a grossly elevated adjusted calcium (3.93 mmol/l), elevated phosphate (1.65 mmol/l) and high urea and creatinine (10.6 and 162 µmol/l, respectively) with normal alkaline phosphatase (48 u/l), and reduced parathyroid hormone (<5 pmol/l). Calcium and creatinine had been normal in blood processed by the laboratory 10 months previously (2.25 and 77 µmol/l, respectively). The patient was admitted under the care of the acute medical team and treated with intravenous fluids and 90 mg of intravenous pamidronate. Her creatinine normalized within a few days and serum calcium over 3 weeks (Figure 1).

You can read the rest of this report here: http://qjmed.oxfordjournals.org/content/104/6/531.long

 

Source: Manson AL1, Chapman N, Wedatilake Y, Balic M, Marway H, Seneviratne SL, Holloway P. Tired with all those supplements? QJM. 2011 Jun;104(6):531-4. doi: 10.1093/qjmed/hcq140. Epub 2010 Aug 13. http://qjmed.oxfordjournals.org/content/104/6/531.long (Full article)