What is commonly observed on physical examination in Myalgic Encephalomyelitis?

• A. Hepatosplenomegaly
• B. Shotty adenopathy
• C. Generalized rash
• D. Splenomegaly

Answer: (B)

Shotty adenopathy refers to small, firm, non-tender, mobile lymph nodes felt as tiny “BB-like” nodules, usually in the cervical or axillary regions. In ME/CFS, mild immune activation can produce this subtle, diffuse lymphoid activity, so you may palpate several small nodes rather than one enlarged gland. This presentation fits ME/CFS better than organomegaly or a generalized rash, which are not typical features of the condition. Hepatosplenomegaly or splenomegaly would suggest liver or spleen involvement from another process, and a generalized rash points toward other infectious or inflammatory diseases. Thus, the presence of shotty adenopathy aligns with the common physical finding in ME/CFS.