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Immune Failure Without Immune Collapse: A Lymphoid-Niche Model of EBV Persistence and Neuro-Endocrine Dysregulation in ME/CFS

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Introduction If one takes Eriksen’s 3-step model of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) at face value, the fundamental defect is not Epstein–Barr virus (EBV) entering an uncontrolled lytic state . Rather, the pathology emerges from a subtler but more durable failure: loss of normal immune containment combined with abnormal lymphoid organization , allowing latently EBV-infected B cells to accumulate in anatomically inappropriate locations , particularly ectopic lymphoid aggregates near or within nervous tissue. In this framework, EBV acts less as an acutely cytopathic pathogen and more as a persistent immune stressor , exploiting vulnerabilities in immune surveillance, B-cell regulation, tissue-level immune architecture, and downstream neuro-endocrine control . The result is a self-reinforcing inflammatory loop that does not require overt viral replication to remain pathogenic. The Core Mechanistic Defect: Two Coupled Failures 1. A tendency to form and maint...
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Case Report: Chronic Hyponatremia Secondary to SIADH in an Older Adult

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Abstract Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a well-recognized cause of chronic hyponatremia, particularly in older adults. Management focuses on identifying the underlying etiology and preventing rapid or severe sodium decline. We report a case of long-standing SIADH with fluctuating sodium levels, managed conservatively with increased oral sodium intake and close laboratory monitoring, highlighting the challenges of unexplained sodium variability and patient-centered self-management. Introduction SIADH is characterized by inappropriate secretion of antidiuretic hormone resulting in impaired free water excretion and dilutional hyponatremia. Chronic hyponatremia may remain asymptomatic but carries risks of neurological complications when sodium levels decline rapidly or fall below critical thresholds. Individualized management is essential, particularly in older patients. Case Presentation A 73-year-old individual with a known diagnosis of SIADH pr...
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