A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report, 2023, Oka

A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report.
Oka T

Background: Some patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complain of persistent fatigue, dyspnea, pain, and cognitive dysfunction. These symptoms are often described as "long COVID". Whether a patient with long COVID might develop myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is of interest, as is the treatment and management of ME/CFS in a post-COVID patient. Here I report a patient, who, after an infection with SARS-CoV-2, developed ME/CFS and recovered after treatment.

Case presentation: The patient was a previously healthy 55-year-old woman who worked as a nurse and became ill with COVID-19 pneumonia. She then presented with severe fatigue, post-exertional malaise, dyspnea, pain, cognitive dysfunction, tachycardia, and exacerbation of fatigue on physical exertion, which persisted for more than 6 months after her recovery from COVID-19 pneumonia. She was bedridden for more than half of each day. The patient was treated from multiple perspectives, which included (1) instructions on eating habits and supplements; (2) cognitive and behavioral modifications for coping with physical, emotional, and cognitive fatigue; (3) instructions on conditioning exercises to improve deconditioning due to fatigue and dyspnea; and (4) pharmacotherapy with amitriptyline and hochuekkito, a Japanese herbal (Kampo) medicine. The patient made a complete recovery after completing the prescribed regimen and was able to return to work as a nurse.

Conclusions: To the best of my knowledge, this is the first detailed report on a patient infected with SARS-CoV-2 followed by long COVID with the signs/symptoms of ME/CFS who recovered after treatment. I hope this case report will be helpful to health care practitioners by its presentation of some of the therapeutic options for alleviating disabling signs/symptoms in patients with post-COVID ME/CFS.

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I haven't looked at them but if interested, the available English references given for Hochuekkito are —

Efficacy and Safety of a Traditional Herbal Medicine, Hochu-ekki-to in the Long-term Management of Kikyo (Delicate Constitution) Patients with Atopic Dermatitis: A 6-month, Multicenter, Double-blind, Randomized, Placebo-controlled Study (2010)
Basic pharmacological mechanisms and clinical evidence of the efficacy of hochuekkito against infectious diseases and its potential for use against COVID-19 (2020)
Bojungikki-tang for cancer-related fatigue: a pilot randomized clinical trial (2010)
Neuroinflammation, Oxidative Stress, and Neurogenesis in a Mouse Model of Chronic Fatigue Syndrome, and the Treatment with Kampo Medicine (2020)

 

Apparently there's psychogenic fever. From the same author —

Psychogenic fever: how psychological stress affects body temperature in the clinical population (2015)

and different Japanese authors, recently referencing that paper —
Psychogenic fever and postural tachycardia syndrome among school-aged children and adolescents with fever of unknown origin (2022)

the latter concluding with:

Those delicate teenage girls... This is the first time I've come across PUO (pyrexia of unknown origin) which is a common childhood referral problem being explained with MUS-like psychologisation.

 

Axilla temperature is the least reliable measurement of them all. It is typically only performed on newborns.

 

ME/CFS is a very variable condition between and within patients. I am sure we can all share anecdotes of people dramatically cutting back their activity levels and seemingly improving dramatically, perhaps attributing that improvement to whichever intervention they were doing at the time, be it diet, gentle exercise, psychotherapy, positive thinking.

One I cite is someone who went on holiday on a Greek island and felt much improved, so she left her job and sold everything she had to raise enough money to return to the island for over six months. With a healthy Mediterranean diet, gentle walking, swimming, lots of rest and sunbathing she believed this resulted in a total recovery. Then returning to full time but temporary job in the UK, within a few days she experienced a major relapse leaving her unable to work again. Having previously left her permanent post she had no entitlement to ill health retirement just general state benefits.

We desperately need good longitudinal data for a reasonable sized cohort. The single case reported here may have recovered or she may simply have learned to manage her symptoms to avoid triggering PEM, but we have no idea if that could be sustained when returning to premorbid activity levels.

 

Uh, literally half recover, at least. Come on this is just weak. A freaking TV show about busting myths was more rigorous than this. And it was for entertainment. Why are entertainers more serious about a freaking TV show than actual medical doctors about their actual job?

Do they literally don't know anything about the overall picture? I mean for years people have insisted that most recover, therefore it's very likely to randomly find people who will recover. Unless this clinician has only treated this patient, this is one case out of who knows?

Of course those claims about everyone recovering were largely aspirational hopium and in fact many do not, but on a year-span most do, this is what was expected given the probabilities.

Why is medicine so bad at statistics and probabilities? And I mean just absolutely catastrophically awful in ways that are hard to put into proper context.

It's a good thing we will have medical and research AIs to allow us to bypass this broken system. Because it is completely broken and unable to commit a competent effort.