Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue. — ME/CFS Atlas
E3 PreliminaryPreliminaryPEM not requiredCase-ControlPeer-reviewedReviewed
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Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue.
Check, J H, Cohen, R · Clinical and experimental obstetrics & gynecology · 2011
Quick Summary
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.
Why It Matters
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.
Observed Findings
Patient with Borrelia burgdorferi seropositivity presented with chronic fatigue unresponsive to three months of doxycycline.
Water load test showed abnormal fluid retention: only 50% excretion of ingested water load while standing for four hours.
Patient showed marked clinical improvement following treatment with dextroamphetamine sulfate.
Chronic fatigue can present as the primary symptom of sympathetic nervous system dysfunction in women, sometimes without accompanying pelvic pain.
Inferred Conclusions
Sympathetic neural hyperalgesia edema syndrome may be misdiagnosed as Lyme disease in women with chronic fatigue.
The water load test may be useful for identifying sympathetic dysfunction in patients with chronic fatigue of unclear etiology.
Treatment with sympathomimetic agents may be effective for chronic fatigue caused by sympathetic nervous system disorders.
Clinicians should consider SNHES in women whose chronic fatigue persists despite treatment of other suspected causes.
Remaining Questions
What is the prevalence of SNHES among ME/CFS patients, and how common is misattribution to Lyme disease?
Is the water load test a validated diagnostic test with established sensitivity and specificity for SNHES?
What This Study Does Not Prove
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 →
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