Myalgic encephalomyelitis (ME) also known as chronic fatigue syndrome (CFS) or ME/CFS, is a chronic, complex multi-system disease that affects children and adolescents as well as adults. Typical age of onset is between the ages of 10 to 19 years and 30 to 39 years and is more common in females. Prevalence estimates for pediatric ME/CFS vary from 0.1 to 0.5%. More than 80% patients report an infectious episode near the onset. Many clinicians are unaware of or question the diagnosis of ME/CFS. In 2015, the US National Academy of Medicine created new clinical diagnostic criteria which require substantial impairment in function accompanied by fatigue, post-exertional malaise (PEM), unrefreshing sleep, and either cognitive impairment or orthostatic intolerance. Children, especially adolescents have orthostatic intolerance more often than adults and is often the most unbearable symptom and may make other symptoms worse. Children and adolescents usually do not have muscle and joint pain unlike adults. The severity of symptoms may range from mild to very severe and can substantially impair occupational, educational, social, and personal activities. The etiology of ME/CFS is uncertain, with studies showing neurologic, immunologic, autonomic, and energy metabolism impairment. As there are no definitive tests, diagnosis relies on history and physical examination and may require multiple visits. There are guidelines for diagnostic testing that can be helpful to diagnose or rule out other conditions and comorbidities. Herein, we describe an adolescent with autism spectrum disorder presenting with orthostatic intolerance as the predominant symptom.

Mahesh Chikkannaiah
Dayton Children's Hospital
United States

Laura Fonseca
Dayton Children's Hospital
United States

Set Kallol
Dayton Children's Hospital
United States

Debra O'Donnell
Dayton Children's Hospital/ Wright State University
United States

Samuel Dzodzomenyo
Dayton Children's Hospital/ Wright State University
United States

Gogi Kumar
Dayton Children's Hospital/ Wright State University
United States