A Case Of Myalgic Encephalitis

Many years ago, I made my first house call in about five years to see a 59-year-old woman who was unable to travel.

- Dr Todd Hoover

She had been essentially housebound due to her illness for years, and this is the story she told. About twenty years ago, in England, she developed an acute flu-like illness. Sharp intestinal pain and fatigue followed by chills and drenching sweats came on over a 5-day period. She developed photophobia, and difficulty finding words. It became increasingly difficult to move: “as if she’d be run over by a truck.” Her body seemed very heavy.

She subsequently developed erythema nodosum [skin disorder] with approximately 18 nodules on both lower legs. They were dark red and very painful nodules that eventually disappeared. Evaluation at that time was negative. The chills, sweats, photophobia, stabbing headaches in the temples, and extreme fatigue persisted intermittently until the present time.

For the past several years she had settled into a fairly severe pattern. She was confined to the house and much of the time, to bed, due to extreme weakness with —

Periodic worsenings including progressive heaviness of the body, especially the extremities

Arms are too tired to lift. Sleeping up to 23 hours per day requiring assistance to eat and go to the bathroom

Sleep is heavy with stertorous breathing. Waking due to headaches. Severe headaches, one-sided and associated with nausea and vomiting

Headache is preceded by hunger and difficulty concentrating

Headaches are particularly worse from using computer screens and overwork

Photophobia worsens and she develops sensitivity to noise and voices.

During the heavy sleep episodes, she reports being partially awake and disquieting at reflecting objects. She gets vertigo, general in-coordination, clumsiness and illegible writing. Concentration is cloudy and there are generally less thoughts.

She develops pain in joints and muscles. Stiffness extends distally and there is frequently sciatica extending to the right calf.