Chronic fatigue syndrome with persisting endotoxemia defined with limulus lysate test

Report of a case and review of the literature

Abstract

This report describes a patient with chronic fatigue syndrome (CFS) with persisting endotoxemia defined with limulus lysate test. A 30-year-old female was admitted to our hospital because general fatigue continued for a long time. She had been treated with anti-inflammatory drugs, steroids and immunosuppressive drugs at another hospital. But these treatments did not improve the symptoms and sign completely. The symptom of swollen lymph nodes and muscle weakness, and the sign of general fatigue, low grade fever, sore throat, myalgias, headaches, althralgias, difficulty thinking and inability to concentrate have been lasted for these ten years. A diagnosis of chronic fatigue syndrome was made based on clinical criterion proposed by Holmes GP et al. Serological studies revealed an elevation of titer of serum antibodies to measles, herpes simplex, herpes zoster, epstein-barr virus and human herpesvirus-6 (HHV-6). HHV-6 specific DNA was not detected in the peripheral blood lymphocytes. Endotoxin defined by limulus lysate test and endospecy was positive. Reduced natural killer cell activity was found in the patient. Phenotypic analysis revealed that the CD57⁺ population was exist (19.7%), but the CD16⁺ population was extremely diminished (2.3%). With psychological approach of explanation alone, her symptoms improved one month later.
There has been growing interest in CFS in Europe and America, and supporting organizations for patients with CFS are at work today. On the other hand, little attention has been focused on CFS in Japan. Clinical diagnosis of the collagen diseases, climacteric psychosis or depression were made for the patients with CFS. It is necessary to make adequate diagnosis and treatment for the patients with CFS in Japan.