ID/CC: Sarah is a 29-year-old female with no significant past medical history presenting with chronic exhaustion since COVID-19 infection 9 months ago.

History of Present Illness: 

• Sarah had a mild COVID-19 infection 9 months ago. She was never hospitalized and initially recovered after 2 weeks.

• Since then, she has developed persistent symptoms, including:

• Fatigue: Severe, constant, not improved by rest, aggravated with exertion.

• Post-exertional malaise (PEM): After light activity (e.g. grocery shopping, 20 min walk), she experiences “crashes” with worsened fatigue, sore throat, and brain fog lasting 2–3 days

• Sleep disturbance: Sleeps 9–10 hours/night but wakes unrefreshed

• Cognitive dysfunction (brain fog): Difficulty concentrating at work, slower processing speed, frequent word-finding pauses

• Orthostatic symptoms: Feels lightheaded and dizzy when standing for more than 10 minutes; improves when lying down

• Denies major depressive disorder, weight loss, or substance use.

Physical Exam: 

• Vitals: Normal at rest, but HR rises from 72 bpm supine → 110 bpm within 8 minutes of standing

• Neuro: No focal deficits

• General: Appears fatigued but in no acute distress

Labs: 

• CBC, CMP, TSH, ESR, CRP all within normal limits

• Ferritin and Vitamin B12 normal