Lazy diagnosis: You have Chronic Fatigue Syndrome!

Recently I saw this posted:

World-renowned Ehlers-Danlos Syndrome (EDS) expert, rheumatologist Professor Rodney Grahame (University College London) points out that, in America, almost 650,000 cases of EDS are missed ANNUALLY, based on studies that suggest almost 95% of cases presenting to clinics are missed, most often diagnosed with other things (Fibro/ME/csf, etc.). 

The reality (or challenge) of CFS research is that many people are misdiagnosis and walk around believing they have CFS because their MDs have not done due diligence. It is likely a good time to list conditions that can present similar to CFS. An item like EDS can be tested (in fact, with 23andMe.com, you may be able to determine if you have the genetic mutation for less than the cost of a single MD appointment)

Autoimmune Disease Interstitial Pneumonia

This was first seen with the onset of interstitial pneumonia spread in Nagoya, Japan in 1995 with 313 chronic pneumonia patients

  • Deemed the same as CFS by some
  • Recurrence of active pneumonia was seen

Chronic Cerebrospinal Venous Insufficiency

  • A CFS diagnosis is often seen prior to this diagnosis
  • Prevalence is 62.5% for patients with multiple sclerosis, 45.8% for patients with Other Neurological Diseases (CFS?), 42.1% for patients with Clinically Isolated Syndrome, and 25.5% for Healthy Controls
  • Associated with IBS, CMV and inflammatory factors

Chronic Epstein Barr virus infection

This was an early name for CFS. Some researchers separate out a subgroup based on specific symptoms seen.

Chronic Lyme

  • 37% of candidate CFS-diagnosis patients tested positive for Lyme
  • Late persistent Lyme disease or Post-Treatment Lyme Syndrome overlaps with CFS
  • Both Lyme and CFS lack reliable tests with the desired accuracy

PO: Some of the Lyme tests will give a false positive if EBV is active (which is often seen in CFS). Neither condition has definitive tests. See Chronic Lyme – A Review

Chronic Post-SARS Syndrome

Professor Emeritus Moldofsky has identified striking similarities with CFS. This is likely just a variation of Post Infection Syndrome.

Ciguatera poisoning

In some cases, symptoms are matches for other conditions, for example, chronic ciguatera fish poisoning, which exhibits similar symptoms and laboratory manifestations as CFS.

Endometriosis

There is some overlap with this condition. Both CFS and endometriosis patients have the following:

  • Higher rates of:
    • Hypothyroidism
    • Fibromyalgia
    • Chronic Fatigue Syndrome
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Sjogren’s syndrome
    • Multiple sclerosis

Eosinophilia-myalgia syndrome

Eosinophilia-myalgia syndrome is indistinguishable from Chronic Fatigue Syndrome.

Gulf War Syndrome

  • GWS patients more often experience headache, diarrhea, and night sweats than others
  • Gulf War illness exhibits similar characteristics to macrophagic myofaciitis, which is caused by aluminum in vaccinations
  • Gene expression in GWS, however, is different from CF

Macrophagic myofasciitis

This condition was first reported in 1998 and is associated with aluminum hydroxide in various vaccines. This syndrome meets both Center for Disease Control and Oxford criteria for Chronic Fatigue Syndrome in about half of macrophagic myofasciitis patients. Aluminum levels are high in many CFS patients.

Young-Onset Monogenetic Parkinsonism

A misdiagnosis of CFS has been seen. On the flip side, since 2015, Parkinson has been associated with microbiome shifts. See PubMed.

Pfisteria

This is also known as Possible Estuary Associated Syndrome (PEAS). Characterized by multiple-system symptoms similar to CFS, deficits in neuropsychological tests of cognitive function, and rapid and severe decrements in visual contrast sensitivity

Phosphate Diabetes

This presents with symptoms similar to CFS; one study found that 10% of CFS patients had been misdiagnosed and had phosphate diabetes.

Sarcoidosis Remission

Clinical remission (47%) of sarcoidosis can result in symptoms matching CFS.

Sjogren’s syndrome

  • Fatigue is often seen
  • 32% of patients with CFS meet criteria
  • Associated with Fibromyalgia
  • Affected population (mainly female, onset at ages 40 to 50) similar
  • B-cells are important player (see Rituximab and CFS remission)
  • Falls into Fibromyalgia/Chronic Fatigue Syndrome disease spectrum
  • Remission reported from Rituximab and immunoglobulin

Traumatic Brain Injury

CFS has been described by some as a disease-caused brain injury. Brain infection and injury can result in over-production of cytokines including TNF. TNF is produced by glia in the brain, and the appropriate level is required for the correct operation of the brain.

Fatigue level was significantly correlated with the following three factors in traumatic brain injury:

  • 55% of patients with TBD have poor sleep quality
  • 36% of patients with TBD have anxiety disorders
  • 65% of patients with TBD have vitamin D deficiency

Misdiagnosis

The following conditions appear to be distinct from CFS but may receive a CFS diagnosis if there is not sufficient due-diligence.

Differential Diagnoses

The Canadian Definition explicitly cites that the following conditions should be excluded before a CFS diagnosis is given:

  • Addison’s disease
  • Cushing’s Syndrome
  • Hypothyroidism
  • Hyperthyroidism
  • Iron deficiency
  • Other treatable forms of anemia
  • Iron overload syndrome
  • Diabetes mellitus
  • Cancer
  • Treatable sleep disorders:
    • upper airway resistance syndrome
    • obstructive or central sleep apnea
  • Rheumatological disorders:
    • rheumatoid arthritis
    • lupus
    • polymyositis

There are a variety of illnesses which are suggested as being different from CFS in the medical literature. These include:

  • Chiari Malformation
  • Chronic anemia
  • Chronic heart disease
  • Chronic infections (e.g., AIDS)
  • Chronic Lyme Disease
  • Connective tissue diseases
  • Drug abuse
  • Endocrine diseases: Addison disease, hypothyroidism
  • Fibromyalgia
  • Inflammatory bowel disease
  • Liver disease
  • Multiple Chemical Sensitivities
  • Multiple Sclerosis
  • Neoplastic disease
  • Primary haemochomatosis (2% probability)
  • Psychiatric Disorders
  • Renal disease
  • Thyroid disease

IACFS/ME lists over sixty differential diagnoses. Some of these are not strictly exclusory. As an example, Vitamin B12 or D deficiency is seen in CFS patients; if CFS resolves when the deficiency is treated, then it is differential.