Except for the tender point exam, the physical exam may show only subtle signs. A positive Romberg and difficulty with tandem walking may be noted on the neurological exam, as well as new difficulty with serial sevens. Other tests, such as rheumatoid factor, antinuclear antibody, Lyme disease antibodies, etc. will be indicated by the history and physical exam. Thyroid abnormalities may appear later in the illness and testing should be repeated in those with a prolonged illness.
Many patients show high antibody levels to any virus measured.
Please note that while some particular additional procedures may be necessary to rule out other illnesses, these should be limited to what is clinically reasonable. Many procedures, particularly ones only remotely pertinent, can be expensive, exhausting, alarming, and discouraging. Management of the diagnostic studies and follow-up treatment should be carried out by a primary care physician with referral to specialists, and limited to only those that are absolutely necessary. It has a recognizable profile as described above and below. . However, there are many differences.