Abstract:
Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem disorder associated with immune dysregulation yet lacks definitive biomarkers or effective therapies. Acute immune perturbations may transiently modulate disease manifestations.
Methods: We report the case of a female patient in her 60s with severe, long-standing ME/CFS who experienced changes in symptom following administration of recombinant zoster vaccine (RZV; Shingrix). Peripheral blood mononuclear cells were analyzed pre- and post-vaccination using flow cytometry, with comparison to a female healthy control. Plasma galectin-9 (Gal-9) levels were quantified by ELISA.
Results: Both RZV doses were associated with rapid, transient remission of symptoms, including improved sleep, cognition, pain, mobility, and respiratory function, followed by relapse. Immunologically, pre-vaccination profiling revealed elevated monocytes, increased CD71+ erythroid cells, and features of T cell exhaustion marked by Gal-9/PD-1 co-expression and impaired cytokine responses. Post-vaccination, monocyte frequency decreased, Gal-9+/PD-1+ T cells were reduced, and NK cell degranulation improved, indicating partial restoration of immune function.
Conclusion: This case demonstrates that immune stimulation via RZV may transiently reverse immune dysfunction and improve clinical symptoms in ME/CFS. These findings support a role for reversible immune exhaustion in disease pathogenesis and highlight potential avenues for biomarker development and therapeutic intervention.
Source: Bigleri A, Alimo ET, Abouda A, Osman M, Cohen Tervaert JW, Elahi S. Transient clinical improvement and immune modulation following recombinant Zoster vaccination in a patient with ME/CFS. Brain Behav Immun Health. 2026 Oct 13;58:101388. doi: 10.1016/j.bbih.2026.101388. PMID: 42927120; PMCID: PMC13694728. https://pmc.ncbi.nlm.nih.gov/articles/PMC13694728/ (Full text)