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January 16, 1991

Chronic Fatigue Syndrome

Author Affiliations

University of Miami (Fla) School of Medicine

University of Miami (Fla) School of Medicine

JAMA. 1991;265(3):357. doi:10.1001/jama.1991.03460030063025

To the Editor.—  We read with interest the article by Gold et al.1 We have recently reported the psychosocial attributes2 and the clinical and immunologic characteristics3 of a sample of 30 subjects. We noted frequent personality and cognitive abnormalities in the cohort, such as moderate to severe depression (as measured by the Hamilton Depression Rating Scale) seen in 79% of the subjects and frequent pathological personality disorders as defined by the Millon Clinical Multiaxial Inventory II.These subjects showed clear evidence of immunologic deficiency, the most notable being low natural killer-cell cytotoxicity (73%), low phytohemagglutinin and pokeweed mitogen response (63%), normal CD4 numbers but abnormal distribution of CD4 subsets, elevated CD8 and I2 + CD8 + cells and low production of interferon-γ by mitogen-stimulated lymphocytes.Perhaps the explanation for the difference in our report and that by Gold et al lies in patient selection. All of the subjects