E3 PreliminaryPreliminaryPEM unclearCase-ControlPeer-reviewedReviewed
A Case Study of Successful Application of the Principles of ME/CFS Care to an Individual with Long COVID.
Petracek, Lindsay S, Broussard, Camille A, Swope, Renee L et al. · Healthcare (Basel, Switzerland) · 2023 · DOI
Quick Summary
A 19-year-old developed severe ME/CFS-like symptoms after COVID-19 infection. Doctors used ME/CFS treatment approaches—including physical therapy, heart rate monitoring, and medications for heart and immune problems—and the patient improved significantly over 2.5 years. This case suggests that treatments developed for ME/CFS may also help some long COVID patients.
Why It Matters
This case demonstrates that ME/CFS diagnostic and management frameworks may have clinical utility for long COVID patients with severe fatigue, potentially opening new treatment pathways. It bridges two post-viral conditions and suggests that existing ME/CFS expertise could be applied to address the growing long COVID population.
Observed Findings
- Patient developed profound fatigue and disability meeting ME/CFS criteria after confirmed SARS-CoV-2 infection
- Diagnostic evaluation identified postural tachycardia syndrome and mast cell activation syndrome
- Physical examination revealed joint hypermobility, pathological reflexes, and range-of-motion restrictions
- Treatment with manual physical therapy and medications targeting orthostatic symptoms and mast cell activation was implemented
- Significant symptom improvement occurred over 30 months of follow-up
Inferred Conclusions
- ME/CFS diagnostic and management principles can be successfully applied to long COVID patients with severe fatigue
- Identifying and treating comorbid conditions such as postural tachycardia syndrome may improve outcomes in post-COVID conditions
- Multidisciplinary evaluation including orthostatic testing and physical therapy assessment may benefit long COVID patients
Remaining Questions
- How many long COVID patients meet ME/CFS criteria and would benefit from this treatment approach?
- Which specific interventions (physical therapy, medications, or both) were most responsible for this patient's improvement?
What This Study Does Not Prove
This single case cannot prove that ME/CFS treatment approaches work for most long COVID patients, as outcomes may be unique to this individual. It does not establish which specific interventions caused improvement, nor does it determine whether findings apply to other age groups, severity levels, or long COVID presentations.
Tags
Symptom:Orthostatic IntolerancePainFatiguePost-Exertional Malaise
Phenotype:Infection-TriggeredSevereLong COVID Overlap
Method Flag:PEM Not DefinedNo ControlsSmall SampleWeak Case DefinitionExploratory Only
Metadata
- DOI
- 10.3390/healthcare11060865
- PMID
- 36981522
- 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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