[Chronic fatigue syndrome--51 cases in the Jikei University School of Medicine].
Hashimoto, N, Kuraishi, Y, Yokose, T et al. · Nihon rinsho. Japanese journal of clinical medicine · 1992
Quick Summary
This study identified 51 patients with ME/CFS diagnosed using official CDC criteria between 1991 and 1992. Most patients were women in their 20s–30s who had been seen by many doctors before receiving a correct diagnosis. Standard blood tests did not reveal abnormal findings, though some immune markers were mildly abnormal. About 57% of patients showed general improvement, and doctors used various medications to manage severe symptoms.
Why It Matters
This early study helped establish that ME/CFS is a recognizable clinical entity with consistent features and that standard medical workups often fail to identify it, validating the experiences of patients repeatedly told they have no medical condition. It also documents that some patients improve with supportive care, offering hope to newly diagnosed individuals.
Observed Findings
77.5% of patients reported flu-like illness or acute infection at disease onset, including 5 cases of infectious mononucleosis
31.3% tested positive for antinuclear factor; 11.8% tested positive for rheumatoid factor
56.8% of patients showed general improvement by follow-up
78% of the cohort were women, with peak incidence in the 20–30 year age group
Standard laboratory studies (CBC, urinalysis, biochemistry, inflammatory markers) showed no characteristic abnormalities
Inferred Conclusions
ME/CFS is a distinct clinical syndrome recognizable by consistent criteria, despite normal routine laboratory testing
Infectious triggers, particularly viral infections, may be common precipitating factors
Pharmacological symptom management (NSAIDs, antidepressants, minor tranquilizers) can provide benefit for severe cases
Many patients experience improvement over time with appropriate recognition and management
Remaining Questions
What mechanisms underlie the infectious trigger observed in 77.5% of cases, and why do some people recover while others develop chronic illness?
What This Study Does Not Prove
This study does not prove the cause of ME/CFS, establish what specific immune abnormalities drive the disease, or determine which treatments are most effective—it only describes what doctors observed in clinical practice. The lack of a control group and reliance on case reports means observed associations (like infectious triggers or female predominance) may not reflect true disease mechanisms. The study cannot separate treatment effects from natural disease progression.
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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