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- Laura Cannon, MD*
- Heather Van Mater, MD, MS*
- Carolyn Pizoli, MD, PhD*
- *Duke Children’s Hospital, Durham, NC
- Address correspondence to Laura Cannon, MD, Division of Pediatric Rheumatology, Department of Pediatrics, Duke Children’s Hospital, 2301 Erwin Rd, Durham, NC 27710. E-mail: laura.cannon{at}duke.edu
AUTHOR DISCLOSURE
Drs Cannon, Van Mater, and Pizoli have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A previously healthy and active 17-year-old boy presents to the clinic for episodic exhaustion, which started 10 months ago. During these episodes, he sleeps all day (up to 23 out of 24 hours) for 7 to 10 days, progressively sleeping less over the course of the episode. These episodes have been occurring as frequently as every 5 to 6 weeks. He will often eat large quantities of food as 1 single meal during these spells, and seems ravenous. He also demonstrates marked irritability and has poor ability to independently function secondary to difficulty expressing his thoughts. He has memory impairment, and parents are concerned about leaving him alone during the episodes. He returns completely back to baseline between these periods. On examination, he is well appearing with normal vital signs and a normal neurological examination. Review of systems is otherwise negative.
Review of previous records show previous hospitalization for these spells where he was evaluated by neurology and had a normal routine electroencephalography (EEG) but did have diffuse slowing on a follow-up EEG performed while he was having symptoms. In addition, he had imaging including computed tomography (CT) scan of the head and magnetic resonance imaging of the brain, which were normal. Drug testing was negative. He had thyroid antibody testing, which was positive (anti-thyroid peroxidase antibody and thyroglobulin antibody), but thyroid function studies were normal. He had been previously diagnosed with a postinfectious chronic fatigue syndrome …
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