Adrenal Dysfunction or Viral?

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I’m looking for a little insight if anyone can help:
About 5-6 months ago my husband had an adverse reaction to a glucocorticosteroid injection(kenalog40). He did not sleep for over two weeks and his body was put under a lot of stress. The original reason he had the steroid injections was that he had bilateral hand weakness which was erroneously diagnosed as tenosynovitis. Since the shot he has developed extreme fatigue, anxiety, brain fog, abnormal neurologic symptoms, insomnia etc and was diagnosed with ME/CFS at the Mayo Clinic. We then met with a Doctor who proposed that it was possible that he had a viral reactivation of EBV or another Herpes virus following iatrogenic immunosuppression from the Steroid. He thinks it’s possible his original hand weakness could have been a virus. His labs showed VCA igg and Nuclear antigen are extremely high.... but it did not show a current active infection on the IgM or Early antigen. It all seems so crazy that he was super human healthy and then pretty much housebound after the shots. He has begun (about 2 weeks ago) to take famvir and his condition has declined... basically his ME symptoms are worse and he’s only taking one tablet a day so far. We are very unsure about this course given that we don’t 100% understand the whole viral theory. The biggest struggle is does he simply have an HPA imbalance from the shot or is it viral? No doctor seems to be able to give a difinitive answer. Has anyone else ever had ME develop following steroid injections? Also what types of symptoms indicate a herx reaction versus just a ME flare? He’s on such a low dose of famvir we weren’t anticipating him to be feeling so bad so soon. ANY insight or related experiences would be so greatly appreciated!
 
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Also his am cortisol was high.... not considered “cushings” by the endocrinologist but higher than normal...he has no weight gain or cushings symptoms besides the ones that are the same as ME. He has flushing but low body.
 

Hip

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His labs showed VCA igg and Nuclear antigen are extremely high.... but it did not show a current active infection on the IgM or Early antigen.
Dr Martin Lerner's criteria for active EBV infection in ME/CFS are elevated antibody titers in the EBV IgM VCA and/or EBV EA diffuse tests by ELISA. Refs: 1 2

Prof Jose Montoya says a Quest EBV IgG VCA titer of 1:640 or higher and a Quest EBV IgG EA titer of 1:160 or higher indicates an active EBV infection in ME/CFS. Ref: 1

So take your pick! Usually its best to get the test results interpreted by an ME/CFS specialist doctor.

Valtrex is an alternative drug used by ME/CFS doctors for treating EBV.

But EBV is not the only virus linked to ME/CFS, and good ME/CFS doctors will test for coxsackievirus B, echovirus, EBV, HHV-6, cytomegalovirus, parvovirus B19, Chlamydia pneumoniae and others. You might find this roadmap document useful.


Dr John Chia found that when steroids are given during the acute phase of a viral infection, this was a recipe for creating ME/CFS. So if your husband's initial hand weakness were caused by a new viral infection, those steroids could have facilitated the virus to cause ME/CFS. So that's one possible theory.
 
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Thank you so much for all this information @Hip
We found that quest would not do the ratio test on EBV anymore. So all we have is a lab test from lab Corp with ELISA Titers for VCA igg of over 600 and NA igg of 450. How do these numbers correlate with diagnosis? His early antigen and IgM were negative.
I guess a secondary question would be has anybody ever developed chronic fatigue from a reactivation of herpes zoster? We don’t have the numbers for that because the igg part of test was not done.
We have heard that herpes Zoster can hang on the dorsal root ganglia of the spine and are wondering if it could have been causing his hand weakness?
His Herpes simplex 1 igg titer was very high and alternately his hhv6 ifa was 1:40. Which I was told was low? We have decided to go with famvir instead of valcyte at this point.
We are hoping the anti vitals don’t cause any problems with cortisol and are not causing harm in that respect. Has anyone ever seen any studies on whether or not antivirals have any affect on cortisol or HPA axis function?
We had a friend propose that he could take a oral steroid and see if it improves or worsen his symptoms to determine whether his problem is from HPA axis Imbalance but he will not even entertain taking a steroid ever again, which is understandable.
Thanks again for any insight!
 

Hip

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We found that quest would not do the ratio test on EBV anymore. So all we have is a lab test from lab Corp with ELISA Titers for VCA igg of over 600 and NA igg of 450.
Yes, that's unfortunately the case, so there are no longer any precise criteria to go by. I did write to many of the leading ME/CFS doctors to ask them if they would supply more up to date titer criteria that I could put in my roadmap, but few replied to my email, and those who did reply did not give any criteria I could use.



I guess a secondary question would be has anybody ever developed chronic fatigue from a reactivation of herpes zoster?
Yes they have, and varicella zoster virus ME/CFS is a very treatable form of this disease that responds well to acyclovir or Valtrex.

Dr John Chia found that around 1.5% of his ME/CFS patients have shingles (varicella zoster virus reactivation) that starts off their whole illness. He observed that within weeks, the antiviral acyclovir can make dramatic improvements to such patients.

Source: ME/CFS Alert - Dr John Chia, Part 1, timecode 6:58