Neuropathology of post-infectious chronic fatigue syndrome

Journal of the Neurological Sciences 2009 (S60-S61)

Cader S., O'Donovan D.G., Shepherd C., Chaudhuri A.

Abstract

Purpose: The pathogenesis of severe and relapsing chronic fatigue after
viral or bacterial infection is unknown. Many patients with post-infectious
chronic fatigue, which is classified as a neurological disease (G93.3,
ICD-10 classification), become disabled and do not recover fully despite
symptomatic and rehabilitative therapy.

Method: We report here the histopathological changes in the dorsal root
ganglia of three female patients with a diagnosis of chronic fatigue
syndrome. All three patients were seen by their local physicians and
specialists who had excluded alternative medical cause for their symptoms of
disabling fatigue and chronic pain. Due to the nature of death, a full
autopsy examination was carried out in each of these cases.

Results: The most remarkable and consistent abnormality was the presence of
active inflammation with T8 lymphocytic infiltration in the dorsal root
ganglion of one patient and evidence of past inflammation (nodules of
Nageotte) in two patients.

Conclusion: Dorsal root ganglion is the gateway for sensory information
reaching the central nervous system. Based on the histopathological changes
observed in three cases, we propose that inflammation of the dorsal root
ganglia may play a key role in the pathogenesis of post-infectious chronic
fatigue. Abnormal processing of sensory information secondary to dorsal root
ganglionitis could potentially contribute to fatigue due to higher perceived
effort and pain because of reduced sensory threshold. This may lead to new
treatment options in a group of patients that currently present a
significant challenge to neurologists.