E3 PreliminaryPreliminaryPEM ?Case-ControlPeer-reviewedMachine draft
Adolescent and Young Adult ME/CFS After Confirmed or Probable COVID-19.
Petracek, Lindsay S, Suskauer, Stacy J, Vickers, Rebecca F et al. · Frontiers in medicine · 2021 · DOI
Quick Summary
This study describes three teenagers and young adults who developed ME/CFS after having COVID-19. All three patients experienced symptoms like dizziness when standing up early in their illness, and by 6 months, all met the clinical criteria for ME/CFS. The researchers noticed several patterns across these patients, including allergies, elevated histamine levels, reduced flexibility, and unusual nerve reflexes—findings that may help identify and treat ME/CFS after COVID-19.
Why It Matters
This study provides early evidence that COVID-19 can trigger ME/CFS in younger populations and identifies potential biomarkers and comorbid features—such as POTS, allergic phenomena, and neuromuscular abnormalities—that could inform diagnostic pathways and targeted treatments. Understanding these features may help clinicians recognize and manage post-COVID ME/CFS earlier in affected adolescents and young adults.
Observed Findings
- All three patients developed orthostatic intolerance and postural tachycardia syndrome within 2 weeks of COVID-19 infection.
- All three patients had strong histories of allergies.
- Two of three patients had elevated plasma histamine levels.
- Two of three patients demonstrated pathological Hoffman reflexes.
- All three patients showed limitations in symptom-free range of motion of limbs and spine.
Inferred Conclusions
- COVID-19 can trigger ME/CFS in adolescents and young adults.
- Multiple comorbid features including POTS, allergies, mast cell phenomena, and neuromuscular limitations may be targets for intervention in post-COVID ME/CFS.
- Further research is needed to determine the pathogenesis of ME/CFS after COVID-19 and the prevalence of these comorbid abnormalities.
Remaining Questions
- What is the true prevalence of ME/CFS following COVID-19 in adolescents and young adults?
- Are elevated histamine and allergic phenomena causative of post-COVID ME/CFS, or are they secondary manifestations?
- What is the optimal treatment approach for post-COVID ME/CFS, and do the identified comorbid features respond to targeted therapies (manual therapy, antihistamines, POTS medications)?
What This Study Does Not Prove
This case report cannot establish the prevalence or true incidence of ME/CFS following COVID-19, as it describes only three patients. It does not prove that the identified comorbid features (allergies, histamine elevation, neuromuscular findings) are specific to post-COVID ME/CFS or present in all affected individuals. The study cannot determine whether these features are causative or simply associated with the condition.
Tags
Symptom:Cognitive DysfunctionOrthostatic IntoleranceFatigue
Biomarker:Blood Biomarker
Phenotype:Infection-TriggeredPediatricLong COVID Overlap
Method Flag:No ControlsSmall SampleExploratory Only
Metadata
- DOI
- 10.3389/fmed.2021.668944
- PMID
- 33996867
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026