FAR from being "all in the mind" chronic fatigue syndrome has been recorded as a cause of death in the UK for the first time. The coroner's verdict is a breakthrough for those who argue that CFS, or myalgic encephalomyelitis, is a physical rather than psychological condition.

On 13 June a UK coroner recorded that 32-year-old Sophia Mirza died from acute aneuric renal failure - failure to produce urine - triggered by dehydration as a result of CFS. Mirza had had the condition for six years. The cause of CFS remains controversial, though it may have its roots in the immune system.

Dominic O'Donovan, a neuropathologist at Oldchurch Hospital in Romford who gave evidence at the inquest, said that Mirza's spinal cord showed inflammation. This, he says, is a clear physical manifestation of CFS.

CFS specialist Jonathan Kerr of St George's, University of London, agrees. He says that the immune system tends to be over-activated in people with CFS, and this may underlie the inflammation of the neurological tissue.

"People have been reluctant to subscribe to the biological side because of the power of the psychiatric lobby," says Kerr.