Check, J H, Cohen, R · Clinical and experimental obstetrics & gynecology · 2011
This study describes a woman who was diagnosed with Lyme disease and treated with antibiotics for chronic fatigue, but her symptoms didn't improve. Doctors then tested her ability to excrete water from her body and found it was impaired, suggesting a problem with her sympathetic nervous system (the part that controls automatic body functions). When she was treated with a stimulant medication instead, she improved significantly.
This study highlights the risk of diagnostic error in ME/CFS, where symptoms may be incorrectly attributed to Lyme disease when another condition (SNHES) is actually responsible. Understanding alternative explanations for chronic fatigue in women is important to prevent unnecessary antibiotic treatment and identify potentially effective interventions. The water load test may represent a useful screening tool for sympathetic dysfunction in fatigued patients.
This single case report cannot establish that SNHES is a frequent cause of ME/CFS, nor can it prove causation between sympathetic dysfunction and chronic fatigue. The study does not demonstrate that the water load test is a validated diagnostic marker for ME/CFS or SNHES, and it is unclear whether this patient's improvement was due to the medication or other factors. Findings from one patient cannot be generalized to the ME/CFS population.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Check, J H & Cohen, R (2011). Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue.. Clinical and experimental obstetrics & gynecology. https://pubmed.ncbi.nlm.nih.gov/22268288/
BibTeX
@article{mecfsatlas-check-2011-sympathetic-neural,
author = {Check, J H and Cohen, R},
title = {Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue.},
journal = {Clinical and experimental obstetrics & gynecology},
year = {2011},
note = {PubMed: 22268288},
url = {https://www.mecfsatlas.com/evidence/check-2011-sympathetic-neural},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/check-2011-sympathetic-neural
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