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February 12, 1988

Fatigue Syndrome-Reply

JAMA. 1988;259(6):843. doi:10.1001/jama.1988.03720060014020

In Reply.  —The chronic fatigue syndrome should be considered only after other relevant diagnoses have been excluded. Dr Lehrer and Ms Hover suggest that chronic cocaine use be added to the list of excludable disorders. Having specifically inquired of over 140 patients with chronic fatigue regarding their histories of illicit drug use, I am left with the impression that cocaine use is not a feature of the population referred to me for study. Nonetheless, among other patient groups cocaine use may be more prevalent, and thus Dr Lehrer and Ms Hover's admonition to consider it is appropriate.There are differences between the presentation of patients with chronic cocaine abuse and that of patients with the chronic fatigue syndrome. While cocaine use is increasingly common among women, it remains most prevalent in men, unlike the chronic fatigue syndrome. Nasal sores or bleeding, chronic cough, vomiting, loss of consciousness, and seizures are