Porter, J, Al-Jarrah, Q, Richardson, S · Case reports in vascular medicine · 2014 · DOI
This case study describes a 34-year-old marathon runner who was initially diagnosed with chronic fatigue syndrome but actually had a rare blood vessel problem called a femoral arteriovenous fistula. This condition, caused by a small injury during a heart catheterization procedure years earlier, created an abnormal connection between an artery and vein in the leg that forced the heart to work much harder than normal. Surgery to repair this fistula completely resolved the patient's fatigue and heart problems, showing that careful medical evaluation is important when fatigue symptoms don't improve with standard treatment.
This case is important because it highlights a potentially serious but treatable medical condition that can masquerade as ME/CFS. Patients and clinicians should be aware that unexplained fatigue, especially with cardiac symptoms, may occasionally stem from vascular abnormalities rather than primary fatigue disorders. Recognizing this diagnostic possibility could lead to appropriate investigation and cure in affected individuals.
This single case report does not establish how common vascular fistulas are among patients diagnosed with ME/CFS, nor does it suggest that most ME/CFS cases have vascular causes. It cannot prove causation between the fistula and fatigue in all patients—this was true for one individual. The study also does not address whether screening for arteriovenous fistulas would be cost-effective or beneficial as part of ME/CFS diagnostic workup.
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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