Post-COVID-19 ME/CFS: a case report of the treatment and recovery of a 17-year-old high-school student

Abstract Background Evidence is accumulating that some patients infected with SARS-CoV-2 develop persistent fatigue and cognitive dysfunction that meets the diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (post-COVID-19 ME/CFS). However, no established treatment exists for this condition, and reports of patients who have recovered remain limited. Because the pathophysiologic mechanisms underlying the disabling symptoms of post-COVID-19 ME/CFS are not yet fully understood, I adopted a multifaceted treatment approach that considers disease severity, functional level, illness beliefs and coping behaviors, social support systems, comorbidities, secondary issues, and phase of recovery. This report describes a high-school student with post-COVID-19 ME/CFS who was, at one point, unable to attend school but ultimately recovered through this comprehensive, multiperspective treatment strategy. Case presentation A 17-year-old girl was referred to my department for severe fatigue that developed after SARS-CoV-2 infection. Despite receiving treatments at other medical facilities, she was still bedridden for more than half of each day. I treated the patient from multiple perspectives, including (1) instruction on eating habits and supplements; (2) instruction on physical activities; (3) instruction on managing cognitive fatigue; (4) environmental adjustment; (5) pharmacotherapy with midodrine, ibudilast, and the traditional Japanese herbal medicines hochuekkito and tokishakuyakusan; (6) facilitation of therapeutic interoceptive awareness; (7) adjustment of disrupted diurnal sleep-wake rhythms; (8) conditioning exercise; (9) instructions for safe recovery; and (10) nurturing self-efficacy. These interventions were introduced progressively, tailored to the patient’s phase of recovery. Approximately one year after her initial consultation, the patient made a full recovery, entered university, and is now enjoying university life. Conclusions This case report describes, in detail, the evaluation and multifaceted treatment of a 17-year-old high-school student with post-COVID-19 ME/CFS who had been unable to attend school but who ultimately recovered and was able to attend university.