Case Study 6
43-year-old white female developed right lower quadrant abdominal pain and constipation in June 2005, when she was training for marathon. The pain was quite severe and lasted about a week. CT scan of the abdomen and pelvis was negative. She rested at home and then went back to work. On July 4th the patient developed recurrent right lower quadrant pain after she had a big feast. She had severe diarrhea. The patient had a colonoscopy, which was essentially normal by biopsy. The patient was subsequently discharged although the diarrhea continued in September. Capsule endoscopy was negative. The patient was given antibiotics without much response. EGD was not done. The patient continued to have a severe sore throat. The patient had low-grade temperature from 100F to 101F along with night sweats, fatigue, diffuse joint pain and myalgia of the right lower extremity.
In January 2006, the patient had significant sore throat, lymphadenopathy. The patient was given antibiotic with subsequent increase in diarrhea. The patient developed increasing night sweats, fatigue, insomnia, irregular menstrual period. Hormonal tests were normal in February 2006.
The patient also had right hip joint pain and had significant increase in blood pressure without documented renal disease. The patient was placed on antihypertensive medication with improvement of the blood pressure.
The patient traveled all over Asia for many years. The patient did develop diarrhea around 2000 or 2001 which lasted for a few months, which recurred a few times every few weeks. The patient had increased allergic rhinitis and sinus congestion. In 2005, between January and June, the patient was training for a marathon before the increase in symptoms. At the present time, the patient could not function for more than 1-2 hours /day before having to lie down. She continued to have low-grade fever and some night sweats, difficulty with mental concentration, fatigue, unrefreshing sleep, nausea and indigestion. Energy level was about 3-4/10 and 8/10 in 1/30 good day. The patient would crash the next day after a good day.
PHYSICAL EXAMINATION: Throat: minimal redness. Neck: minimal anterior and posterior cervical lymph nodes without thyroid enlargement. Abdomen: epigastric and right lower quadrant tenderness. Extremities: mild muscle tenderness, without edema, clubbing or cyanosis. Neurological unremarkable.
Enterovirus staining of the stomach biopsies showed extensive VP1 staining (magnification 100x)
ASSESSMENT: Chronic fatigue syndrome with prior gastrointestinal illness. The patient had prior episodes of diarrhea back in 2000/2001 after she traveled to Asia, which raised suspicion of enterovirus infection. In 2005, between January and June, it was possible that the increase in physical exercise resulted in the relapse of this chronic enterovirus infection. Within one month she responded to Chinese herbs, and continued to take these herbs for more than 1 1/2 years. Energy level is now 8/10 most of the time with only few bad days (5/10) before her periods.
43-year-old white female developed right lower quadrant abdominal pain and constipation in June 2005, when she was training for marathon. The pain was quite severe and lasted about a week. CT scan of the abdomen and pelvis was negative. She rested at home and then went back to work. On July 4th the patient developed recurrent right lower quadrant pain after she had a big feast. She had severe diarrhea. The patient had a colonoscopy, which was essentially normal by biopsy. The patient was subsequently discharged although the diarrhea continued in September. Capsule endoscopy was negative. The patient was given antibiotics without much response. EGD was not done. The patient continued to have a severe sore throat. The patient had low-grade temperature from 100F to 101F along with night sweats, fatigue, diffuse joint pain and myalgia of the right lower extremity.
In January 2006, the patient had significant sore throat, lymphadenopathy. The patient was given antibiotic with subsequent increase in diarrhea. The patient developed increasing night sweats, fatigue, insomnia, irregular menstrual period. Hormonal tests were normal in February 2006.
The patient also had right hip joint pain and had significant increase in blood pressure without documented renal disease. The patient was placed on antihypertensive medication with improvement of the blood pressure.
The patient traveled all over Asia for many years. The patient did develop diarrhea around 2000 or 2001 which lasted for a few months, which recurred a few times every few weeks. The patient had increased allergic rhinitis and sinus congestion. In 2005, between January and June, the patient was training for a marathon before the increase in symptoms. At the present time, the patient could not function for more than 1-2 hours /day before having to lie down. She continued to have low-grade fever and some night sweats, difficulty with mental concentration, fatigue, unrefreshing sleep, nausea and indigestion. Energy level was about 3-4/10 and 8/10 in 1/30 good day. The patient would crash the next day after a good day.
PHYSICAL EXAMINATION: Throat: minimal redness. Neck: minimal anterior and posterior cervical lymph nodes without thyroid enlargement. Abdomen: epigastric and right lower quadrant tenderness. Extremities: mild muscle tenderness, without edema, clubbing or cyanosis. Neurological unremarkable.
Enterovirus staining of the stomach biopsies showed extensive VP1 staining (magnification 100x)
ASSESSMENT: Chronic fatigue syndrome with prior gastrointestinal illness. The patient had prior episodes of diarrhea back in 2000/2001 after she traveled to Asia, which raised suspicion of enterovirus infection. In 2005, between January and June, it was possible that the increase in physical exercise resulted in the relapse of this chronic enterovirus infection. Within one month she responded to Chinese herbs, and continued to take these herbs for more than 1 1/2 years. Energy level is now 8/10 most of the time with only few bad days (5/10) before her periods.