Chronic Fatigue Syndrome (Myalgic Encephalomyelitis) Clinical Presentation

Updated: Sep 06, 2020
  • Author: Jefferson R Roberts, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Patients with chronic fatigue syndrome (myalgic encephalomyelitis) typically report experiencing postexertional fatigue and feeling excessively tired after relatively normal tasks that they did for years before CFS without any particular problem. Patients also report fatigue even after prolonged periods of rest or sleep. At least one quarter of patients with CFS are bed- or house-bound at some point in their illness. Patients with CFS often report a history of antecedent flulike infection that precipitated the prolonged state of fatigue and followed the initial illness.

Patients with CFS typically report problems with short-term memory but not with long-term memory. They may also report verbal dyslexia that manifests as the inability to find or say a particular word during normal speech. This typically disturbs patients with CFS and may interfere with their occupation.

The National Academy of Medicine notes 5 main symptoms of CFS [5] :

  • Reduction or impairment in ability to carry out normal daily activities, accompanied by profound fatigue
  • Postexertional malaise (worsening of symptoms after physical, cognitive, or emotional effort)
  • Unrefreshing sleep
  • Cognitive impairment
  • Orthostatic intolerance (symptoms that worsen when a person stands upright and improve when the person lies back down)

Physical Examination

Physical examination often reveals no abnormalities. Some patients may have positive orthostatic vital signs.

Many patients with or without CFS have small, moveable, painless lymph nodes that most commonly involve the neck, axillary region, or inguinal region. A single lymph node that is very large, tender, or immobile suggests a diagnosis other than CFS. Similarly, generalized adenopathy suggests a diagnosis other than CFS.

In the oropharynx, purple or crimson crescent discoloration of both anterior tonsillar pillars in the absence of pharyngitis is a frequent marker in patients with CFS. The cause of crimson crescents is unknown, but they are common in patients with CFS. Nonetheless, crimson crescents are not specific for CFS.

Trigger points, which suggest fibromyalgia, are absent in patients with CFS. Fibromyalgia and CFS rarely coexist in the same patient.