title: A chronic "postinfectious" fatigue syndrome associated with benign lymphoproliferation, B-cell proliferation, and active replication of human herpesvirus-6.
abstract: A 17-year-old, previously healthy woman developed an acute "mononucleosis-like" illness with an associated "atypical" pneumonitis, followed by years of debilitating chronic fatigue, fevers, a 10-kg weight loss, night sweats, and neurocognitive symptoms. Thereafter, her sister developed a similar but less severe illness. The patient developed marked, chronic lymphadenopathy and splenomegaly, with associated persistent relative lymphocytosis and atypical lymphocytosis and with thrombocytopenia. After 3 years of illness, a splenectomy was performed, which resulted in some symptomatic improvement, prompt weight gain, and resolution of all hematologic abnormalities. Serial immunologic studies revealed a strikingly elevated number of activated B lymphocytes and a T lymphopenia, which improved but did not return to normal postsplenectomy. No causal association was found with any of several infectious agents that could produce such a lymphoproliferative illness. However, both the patient and her sister had evidence of active infection with the recently discovered human herpesvirus-6. Seven years after the onset of the illness, the patient and her sister remain chronically ill.
authors.affiliation: University of Washington School of Medicine, Seattle 98121.
authors.forename: D
authors.initials: D
authors.lastname: Buchwald
authors.forename: A S
authors.initials: AS
authors.lastname: Freedman
authors.forename: D V
authors.initials: DV
authors.lastname: Ablashi
authors.forename: J L
authors.initials: JL
authors.lastname: Sullivan
authors.forename: M
authors.initials: M
authors.lastname: Caligiuri
authors.forename: D S
authors.initials: DS
authors.lastname: Weinberg
authors.forename: C G
authors.initials: CG
authors.lastname: Hall
authors.forename: R L
authors.initials: RL
authors.lastname: Ashley
authors.forename: C
authors.initials: C
authors.lastname: Saxinger
authors.forename: N
authors.initials: N
authors.lastname: Balachandran
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000954:Antigens, Surface / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology*; D015673:Fatigue Syndrome, Chronic / Q000276:immunology* / Q000601:surgery; D005260:Female; D006566:Herpesviridae Infections / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000276:immunology; D015654:Herpesvirus 6, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D016130:Immunophenotyping; D007694:Killer Cells, Natural / Q000276:immunology; D008213:Lymphocyte Activation / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D013156:Splenectomy; D013601:T-Lymphocytes / Q000276:immunology; D014779:Virus Replication / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D000954:Antigens, Surface