CDC Case Challenge: A Woman With Fatigue, Palpitations, and Headache

Jennifer R. Chevinsky, MD, MPH; Sallyann M. Coleman King, MD, MSc; Robert A. Bonacci, MD, MPH; Brendan R. Jackson, MD, MPH; Alyson B. Goodman, MD, MPH; Jessica Rogers-Brown, PhD, MPH; Valentine Wanga, PhD, MS; Jennifer R. Cope, MD, MPH; Stacey Konkle, PhD, MPH; Miriam Nji, MD, MPH; Melissa Briggs-Hagen, MD, MPH; Elizabeth R. Unger, PhD, MD; Brook Belay, MD, MPH; Sharon Saydah, PhD


September 02, 2021

Editorial Collaboration

Medscape &

Making the Diagnosis

Lyme disease, mononucleosis, COVID-19, and Chikungunya can all cause fatigue; however:

  • This patient's husband contracted an illness during which he lost his sense of taste and smell, a commonly reported symptom of COVID-19 disease.

  • The patient has experienced a cluster of symptoms, including fatigue, palpitations, headache, difficulty sleeping, postexertional malaise (the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12-48 hours after activity and lasting for days or even weeks), and difficulty thinking or concentrating (sometimes referred to as "brain fog"), all commonly reported with post-COVID conditions.

  • The patient's CBC and CMP laboratory results are all normal, a common finding in patients who experience post-COVID conditions.

The highest consideration on the differential diagnosis list should be post-COVID conditions following an asymptomatic SARS-CoV-2 infection.

"Post-COVID conditions" is an umbrella term for the wide range of physical and mental health symptoms that some patients experience four or more weeks after SARS-CoV-2 infection, including patients who had initial mild or asymptomatic acute infection. These post-COVID conditions may also be known as long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID.

Although older patients may have an increased risk for severe acute COVID-19 disease and related ongoing symptoms, younger patients, including those in good health before SARS-CoV-2 infection, have also reported debilitating post-COVID conditions months after acute illness. Multiple possible onset patterns for post-COVID conditions have been identified that further exemplify their heterogeneity, including, but not limited to: (1) persistent symptoms and conditions that begin at the time of acute COVID-19 illness; (2) new-onset late sequelae following asymptomatic disease or a period of acute symptom relief or remission; or (3) an evolution of symptoms and conditions that include some persistent symptoms (eg, shortness of breath) with the addition of new symptoms or conditions over time (eg, cognitive difficulties).

The patient's CBC and CMP laboratory tests are all normal, which is not uncommon for patients experiencing post-COVID conditions. Objective laboratory findings should not be used as the only measure or assessment of a patient's well-being; lack of laboratory abnormalities does not invalidate the existence, severity, or importance of a patient's symptoms or conditions.

For more background information about post-COVID conditions, see the background, general clinical considerations, and patient history and physical exam sections of the CDC interim guidance.