While acknowledging that it is a very debilitating problem for many of these patients, there is really NO agreed organic pathology in CFS beyond that secondary to chronic physical deconditioning. No shortage of hypotheses (chronic infection et al) but none that have stood the test of time. It's hard to see the clinical utility in immunophenotyping unless it's part of a well defined research protocol (sorry if that's the case Mike, you didn't say). The only justifiable investigations in routine clinical management are those directed at excluding a treatable alternative diagnosis eg hypothyroidism, Vitamin B12 deficiency, SLE. I have a number of patients with Chronic Fatigue Syndrome / Fibromyalgia (90% of patients with either label fulfill criteria for the other) and only wish we had something more effective to offer - unfortunately treatment is often as unrewarding as lab investigation. Lachy McLean Rheumatologist / Clinical Immunologist
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