Ms H is a 56-year-old educator currently on medical leave of absence. She has an 11-year history of chronic fatigue that at times has been disabling. She has commercial managed care health insurance through her work.Prior to her illness, Ms H was well, a successful and energetic teacher who was physically very active. In 1986 she developed the sudden onset of profound fatigue, about 1 month after a flulike illness characterized by fever, chills, myalgias, and sore throat. She thought she had infectious mononucleosis, but laboratory tests did not confirm the diagnosis. Titers for Epstein-Barr infection were found to be elevated soon thereafter. Since that time, she has noted extraordinary weakness, finding herself able to walk only a few blocks, followed by exhaustion that forces her to spend many hours in bed. She often finds herself unable to concentrate. She reports she periodically has had "swollen glands"
Komaroff AL. A 56-Year-Old Woman With Chronic Fatigue Syndrome. JAMA. 1997;278(14):1179-1185. doi:10.1001/jama.1997.03550140071043