E3 PreliminaryPreliminaryPEM requiredCase-ControlPeer-reviewedReviewed
A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report.
Oka, Takakazu · BioPsychoSocial medicine · 2023 · DOI
Quick Summary
This case report describes a nurse who developed ME/CFS symptoms after recovering from COVID-19, including severe fatigue, pain, brain fog, and heart palpitations that lasted over 6 months. She received treatment combining dietary advice, supplements, behavioral strategies, exercise conditioning, and two medications (amitriptyline and a Japanese herbal medicine called hochuekkito), and eventually recovered fully and returned to work. This is the first detailed report showing that someone with post-COVID ME/CFS can recover with comprehensive multimodal treatment.
Why It Matters
This case demonstrates that ME/CFS developing after COVID-19 infection may be reversible with integrated treatment approaches combining behavioral, pharmacological, and lifestyle interventions. The successful recovery provides hope and a potential therapeutic framework for clinicians managing post-COVID ME/CFS patients, who currently have limited evidence-based treatment options.
Observed Findings
- Patient developed ME/CFS symptoms (severe fatigue, post-exertional malaise, dyspnea, cognitive dysfunction, tachycardia) persisting >6 months after COVID-19 pneumonia recovery
- Patient was bedridden >50% of each day at presentation
- Multimodal treatment included dietary/supplement modifications, cognitive-behavioral coping strategies, conditioning exercises, amitriptyline, and hochuekkito
- Patient achieved complete recovery and returned to full-time nursing work following treatment completion
Inferred Conclusions
- Post-COVID ME/CFS may be reversible in some patients with comprehensive multimodal treatment
- Integrated approaches combining behavioral, pharmacological, nutritional, and exercise interventions may address multiple pathophysiological mechanisms in post-COVID ME/CFS
- Amitriptyline and hochuekkito may have therapeutic potential as adjunctive treatments for post-COVID ME/CFS
Remaining Questions
- Which specific treatment components were responsible for recovery, and could improvement have occurred with fewer interventions?
- What patient characteristics predict treatment responsiveness in post-COVID ME/CFS?
- How generalizable are these findings to other post-COVID ME/CFS patients with different ages, comorbidities, or disease severities?
What This Study Does Not Prove
This single case report cannot establish which specific treatment components were most effective, whether the same approach works for other patients, or whether recovery would have occurred without intervention. It does not demonstrate causation between COVID-19 and ME/CFS development, nor can findings be generalized beyond this individual patient.
Tags
Symptom:Post-Exertional MalaiseCognitive DysfunctionPainFatigueTemperature DysregulationSensory Sensitivity
Phenotype:Infection-TriggeredSevereLong COVID Overlap
Method Flag:Weak Case DefinitionNo ControlsSmall SamplePEM Not DefinedExploratory Only
Metadata
- DOI
- 10.1186/s13030-022-00260-3
- PMID
- 36855180
- Review status
- Editor reviewed
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 12 April 2026
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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