Moderator Note: This thread was split from Flash of insight: Viral Meningitis @Asa, @duncan Paul Cheney has repeatedly said he can't tell the difference between his patients with CFS and those with post-treatment Lyme disease. He has also said he and Ritchie Shoemaker, who treats people for responses to mycotoxins, trade patients. This sounds like an autoimmune problem triggered by external factors. These are not the only possibilities. Paraneoplastic syndromes may involve only a few cancer cells which can't be directly detected. It is the powerful immune response that gets attention. You may later find a cancer. I think this may have happened with Gilda Radner, who had a history of problems like bulimia, long before she was diagnosed with ovarian cancer too late for treatment to save her life. We have never gotten answers to questions concerning a relation between rare lymphomas and ME/CFS because everyone diagnosed with lymphoma is said never to have had CFS. Those patients not known to have developed lymphomas show levels of nagalase (α-N-acetylgalactosaminidase) comparable to cancer patients, which also could indicate autoimmune involvement. If either infection or neoplasms can trigger autoimmune responses so selective they only attack some molecular component of a particular class of receptors it is unlikely this will show up on an MRI or in typical pathological tissue examinations. This would bring the term encephalomyelitis into question. In the case I mentioned, there was no visible evidence of inflammation on MRIs, yet the term encephalitis is used because of dramatic effects on the brain apparent in EEGs, as well as the discovery of leukocytes in cerebrospinal fluid. In another disease where autoimmune response against postsynaptic neuromuscular junctions is known, myasthenia gravis, severe weakness is the result. Autoimmune responses can be highly specific or ridiculously broad, as happens in connective tissue disorders. We have not begun to exhaust the possibilities. Added: I've now reached the point in the book where treatment began to work, one part of this was Rituximab, still another indication of an autoimmune/neoplasm problem. Moderator Note: The following part of anciendaze's post was moved from another of his posts in the viral meningitis thread: ----- On a different subject, which relates to the mention I made above of paraneoplastic syndromes, I started to search for connections between autoimmune diseases and cancers. There is a great deal of material on autoimmune disease as the result of cancer treatment, these being considered the lesser of two evils. This was not what I was looking for. I wanted to see how a preceding autoimmune disease affected incidence of diagnosed cancer. Anyone else who is interested in the association between particular autoimmune disorders and particular cancers may find this reference I turned up useful. Although causation is still a fairly large question, there is absolutely no doubt patients with various autoimmune diseases do experience higher rates of particular kinds of cancer. I suspect some "autoimmune diseases" will ultimately be reclassified as paraneoplastic. Common thinking may be to suggest that the autoimmune condition causes cancer, but it is equally plausible that the cancer causes the autoimmune response while remaining below current thresholds for detection as cancer per se. In terms of medical specializations there is a great distance between oncology and rheumatology. If there had been more communication I believe paraneoplastic diseases would have been discovered earlier.