Case Study 5
A 29-year-old white female developed recurrent sinus infection and severe vomiting during her second pregnancy 6 years earlier, though she did not have any difficulty with her first pregnancy. However, she had vomiting again in her third pregnancy two years later and continued to have recurrent sinus congestion. In June 2004, the patient developed sore throat and right cervical lymphadenopathy, lower abdominal pain, increasing nausea, sinus congestion. The patient did not have any diarrhea. The patient was given amoxicillin with resolution of the sore throat in 5 days. The patient has been tired ever since. Initially her energy level was as low as 3/10 with pain over the neck, shoulder, arm and increasing migraine headache. She did have mild night sweats, mild brain fog only with the headache. The sinus congestion would worsen with her worst days. In general, energy level has improved in the last year and a half. Now her energy level is about 5-6/10 but she still feels bad with a level of 3-4/10 at least twice a month. The patient does not do exercise but is very busy taking care of three kids.
Recent laboratory studies done on November 9, 2005 showed normal CBC, chemistry panel, UA, HbA1C, TSH, ESR. EBV VCA IgG was 160 (normal <90) with a negative IgM. CMV IgM was 1.4 (0-0.8). CVB antibody was 1:32-1:64 by CF method. The patient has frequent nausea especially at night, diffuse myalgia. Coxsackievirus B3 antibody and echovirus antibody titers were 1:80 and 1:160, respectively.
PAST MEDICAL HISTORY: Hiatal hernia and probable IBS; had EGD/colonoscopy that showed mild inflammation in the antrum.
PHYSICAL EXAMINATION: Throat red patches over throat. Abdomen- tender over epigastrium, both lower quadrants. Extremities tender over all the muscle groups. Neurological � normal.
Stomach biopsies done in 2006 showed extensive viral protein staining (100 x magnification) and tested positive enterovirus RNA.
ASSESSMENT: Chronic fatigue syndrome that started with one enterovirus infection that dated back to sinus/GI infection during her second pregnancy. This is likely enterovirus infection due to the nature of the symptoms. However, the infection was not eradicated during pregnancy since the immune system was likely shifted to a Th2-dominant response. The patient did have an endoscopy 1 1/2 years earlier, and a biopsy tested positive for enteroviral protein and viral RNA. The patient responded to Chinese herbs.
A 29-year-old white female developed recurrent sinus infection and severe vomiting during her second pregnancy 6 years earlier, though she did not have any difficulty with her first pregnancy. However, she had vomiting again in her third pregnancy two years later and continued to have recurrent sinus congestion. In June 2004, the patient developed sore throat and right cervical lymphadenopathy, lower abdominal pain, increasing nausea, sinus congestion. The patient did not have any diarrhea. The patient was given amoxicillin with resolution of the sore throat in 5 days. The patient has been tired ever since. Initially her energy level was as low as 3/10 with pain over the neck, shoulder, arm and increasing migraine headache. She did have mild night sweats, mild brain fog only with the headache. The sinus congestion would worsen with her worst days. In general, energy level has improved in the last year and a half. Now her energy level is about 5-6/10 but she still feels bad with a level of 3-4/10 at least twice a month. The patient does not do exercise but is very busy taking care of three kids.
Recent laboratory studies done on November 9, 2005 showed normal CBC, chemistry panel, UA, HbA1C, TSH, ESR. EBV VCA IgG was 160 (normal <90) with a negative IgM. CMV IgM was 1.4 (0-0.8). CVB antibody was 1:32-1:64 by CF method. The patient has frequent nausea especially at night, diffuse myalgia. Coxsackievirus B3 antibody and echovirus antibody titers were 1:80 and 1:160, respectively.
PAST MEDICAL HISTORY: Hiatal hernia and probable IBS; had EGD/colonoscopy that showed mild inflammation in the antrum.
PHYSICAL EXAMINATION: Throat red patches over throat. Abdomen- tender over epigastrium, both lower quadrants. Extremities tender over all the muscle groups. Neurological � normal.
Stomach biopsies done in 2006 showed extensive viral protein staining (100 x magnification) and tested positive enterovirus RNA.
ASSESSMENT: Chronic fatigue syndrome that started with one enterovirus infection that dated back to sinus/GI infection during her second pregnancy. This is likely enterovirus infection due to the nature of the symptoms. However, the infection was not eradicated during pregnancy since the immune system was likely shifted to a Th2-dominant response. The patient did have an endoscopy 1 1/2 years earlier, and a biopsy tested positive for enteroviral protein and viral RNA. The patient responded to Chinese herbs.