Natural history of the eosinophilia-myalgia syndrome
Article Abstract:
Eosinophilia-myalgia syndrome has affected some individuals who took supplements of the amino acid L-tryptophan. This illness is characterized by a number of signs and symptoms, including elevated levels of the white blood cells known as eosinophils and muscle aches (myalgias). Other symptoms that have been described include fatigue, fever, swelling, hair loss, joint pains, lung disease, nerve damage, and skin changes. A group of 45 patients identified with the eosinophilia-myalgia syndrome were followed for one year to determine what symptoms occurred most frequently, and in what order those symptoms typically appeared. The patients were mostly white women, with an average age of 49 years. The earliest symptoms included the muscle aches and fatigue, which were generally followed by cough and shortness of breath. One patient's lung disease progressed so far that she became a candidate for heart-lung transplant. Rash, hair loss, swelling, numbness, and tingling typically began in the first month of the illness. Difficulty with concentration, memory loss, and language difficulties were reported by 15 percent of the patients, and these symptoms seemed to worsen as the illness progressed. Appropriate treatment for this illness has not yet been determined. Some patients were treated with prednisone, a steroid. No objective improvement was seen in patients treated with steroids, but they tended to report that prednisone was the most effective treatment they had been given. The cause of the illness seems to have been a contaminant in the L-tryptophan preparations the patients were taking. The natural course of the disease in most of the patients studied seemed to consist of four to six months of progressive symptoms, followed by very slow improvement. Follow-up is continuing in these patients to determine the long-term consequences of the eosinophilia-myalgia syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1991
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The eosinophilia-myalgia syndrome with neuritis associated with L-tryptophan use
Article Abstract:
L-tryptophan is an amino acid essential for normal growth in infants and nitrogen balance in adults. Tryptophan is the precursor of several important substances in the body including serotonin, which is a chemical important in brain function. Tryptophan is used as an over the counter remedy for anxiety and insomnia, but has recently been found to cause a potentially life-threatening condition known as eosinophilia-myalgia syndrome. This syndrome produces diffuse muscle pain and an increased number of circulating eosinophils, a type of white blood cell increased by allergies and infections, and decreased by corticosteroids. A case is described of a 48 year old woman who sought medical care because of severe muscle pain. Six weeks prior to her admission, she developed a pain in her upper-back which spread to her shoulders, upper arms, thighs and face that could not be relieved by aspirin. A general lethargy accompanied her pain which she characterized as an "intermittent stinging sensation". Eight days before hospitalization, the patient developed a sore throat and blisters on the upper palate. On admission, blood tests revealed: abnormal liver function tests and an elevated number of eosinophils, and an increased sensitivity to pain. She had been taking hydrocodone and viscous lidocaine for pain and alprazolam for anxiety and insomnia. Additionally, she was taking six tablets a day, 500 mg/tablet, of l-tryptophan for the last five months. The patient was started on the corticosteroid prednisone, 60 mg/day, and her: muscle pain diminished, eosinophil count returned to normal within one week, and liver function tests returned to normal within three months. L-tryptophan has now been withdrawn from the market due this problem. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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The clinical spectrum of the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion: clinical features in 20 patients and aspects of pathophysiology
Article Abstract:
L-tryptophan, an over-the-counter drug once available in health food stores and from other sources (and now no longer available in the United States) has been associated with serious blood cell and other systemic diseases. Eosinophilia, an overproduction of certain red blood cells (eosinophils), was first associated with severe muscle pains (myalgia) in three patients in New Mexico in 1989. This combination of symptoms is rare, and in these cases was associated with taking L-tryptophan. Other cases were soon reported. The Mayo Clinic saw 20 patients from various states, 19 of whom met the Centers for Disease Control (CDC) criteria for the eosinophilia-myalgia syndrome. Neither the dose of L-tryptophan nor the length of time it was taken was important in these cases. In studying these 20 patients, other organ dysfunctions were found, including inflammation of the covering of muscles (fasciitis), inflammation of the lung (pneumonitis), pulmonary hypertension, inflammation of the heart muscle (myocarditis), symptoms involving nerve endings (peripheral neuropathy), inflammation of the brain (encephalopathy) and the biliary tree, and inflammation of the bladder (cystitis). No one knows why these reactions occur, but L-tryptophan itself is not thought to be the culprit. The most probable cause is thought to be an autoimmune response. The syndrome does respond to immunotherapy and complete withdrawal of L-tryptophan, but the best treatment as yet remains unknown, and no one knows what the long-term effect will be on patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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