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Open Access Highly Accessed Case report

Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report

Takakazu Oka1*, Yoshio Kanemitsu12, Nobuyuki Sudo1, Haruo Hayashi3 and Kae Oka4

Author Affiliations

1 Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan

2 Section of Psychosomatic Medicine, Department of General Medicine, Fukuoka Dental College, Fukuoka, Japan

3 Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu 807-8555, Japan

4 Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan

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BioPsychoSocial Medicine 2013, 7:7  doi:10.1186/1751-0759-7-7

Published: 8 March 2013

Abstract

Background

Low-grade fever is a common symptom in patients with chronic fatigue syndrome (CFS), but the mechanisms responsible for its development are poorly understood. We submit this case report that suggests that psychological stress contributes to low-grade fever in CFS.

Case presentation

A 26-year-old female nurse with CFS was admitted to our hospital. She had been recording her axillary temperature regularly and found that it was especially high when she felt stress at work. To assess how psychological stress affects temperature and to investigate the possible mechanisms for this hyperthermia, we conducted a 60-minute stress interview and observed the changes in the following parameters: axillary temperature, fingertip temperature, systolic blood pressure, diastolic blood pressure, heart rate, plasma catecholamine levels, and serum levels of interleukin (IL)-1β and IL-6 (pyretic cytokines), tumor necrosis factor-α and IL-10 (antipyretic cytokines). The stress interview consisted of recalling and talking about stressful events. Her axillary temperature at baseline was 37.2°C, increasing to 38.2°C by the end of the interview. In contrast, her fingertip temperature decreased during the interview. Her heart rate, systolic and diastolic blood pressures, and plasma levels of noradrenaline and adrenaline increased during the interview; there were no significant changes in either pyretic or antipyretic cytokines during or after the interview.

Conclusions

A stress interview induced a 1.0°C increase in axillary temperature in a CFS patient. Negative emotion-associated sympathetic activation, rather than pyretic cytokine production, contributed to the increase in temperature induced by the stress interview. This suggests that psychological stress may contribute to the development or the exacerbation of low-grade fever in some CFS patients.

Keywords:
Chronic fatigue syndrome; Stress-induced hyperthermia; Psychogenic fever; Stress interview; Cytokine