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Eosinophilia-Myalgia Syndrome: A Clinical Case Series of 21 Patients

Eosinophilia-Myalgia Syndrome: A Clinical Case Series of 21 Patients Abstract We reviewed 21 cases of eosinophilia-myalgia syndrome to describe the range of clinical findings in these patients. Most patients were women (20 [95%]) and middle-aged (mean, 46 years) and had taken the food supplement L-tryptophan (95%). All cases involved eosinophilia (eosinophil count, 2.0 × 109/L) and incapacitating myalgias. Fourteen (88%) of the 16 patients tested had mild liver function abnormalities. Aldolase levels were abnormal in all patients tested. Muscle biopsies were done in five patients; four showed eosinophilic perimyositis, and one had interstitial inflammation. No physical finding was pathognomonic or universal, but muscle tenderness, tachycardia, and rash were the most common signs found during physical examinations. Seven patients were treated with prednisone, and six showed improvement in muscle pain and a decrease in eosinophilia. The cause of this disorder is still unknown. (Arch Intern Med. 1991;151:533-537) References 1. Lakhanpal S, Duffy J, Engel AG. Eosinophilia associated with perimyositis and pneumonitis . Mayo Clin Proc. 1988;63:37-41.Crossref 2. Centers for Disease Control. Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States, as of January 9, 1990 . MMWR. 1990;39:14-15. 3. Eidson M, Philen RM, Sewell CM, Voorhees R, Kilbourne EM. L-Tryptophan and eosinophilia myalgia syndrome in New Mexico . Lancet. 1990;1:645-648.Crossref 4. Centers for Disease Control. Eosinophilia-myalgia syndrome—New Mexico . MMWR. 1989;38:765-767. 5. Centers for Disease Control. Eosinophilia-myalgia syndrome and L-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989 . MMWR. 1989;38:785-788. 6. Centers for Disease Control. Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States . MMWR. 1989;38:842-843. 7. Varga J, Peltonen J, Uitto J, Jimenez S. Development of diffuse fasciitis with eosinophilia during L-tryptophan treatment: demonstration of elevated type I collagen gene expression in affected tissues . Ann Intern Med. 1990;112:344-351.Crossref 8. Hertzman PA, Blevins WL, Mayer J, et al. Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan . N Engl J Med. 1990;322:869-873.Crossref 9. Silver RM, Heyes MP, Maize JC, et al. Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan . N Engl J Med. 1990;322:874-881.Crossref 10. Pfanner TP, Person DA, Berenberg JL, Gayle EL, Lockett LJ. Eosinophilia-myalgia syndrome associated with L-tryptophan . Lancet. 1990;1:353-354.Crossref 11. Amor B, Rajzbaum G, Poiraudeau S, Haas C, Kahan A. Eosinophiliamyalgia linked with L-tryptophan . Lancet. 1990;1:420.Crossref 12. Flannery MT, Wallach PM, Espinoza LR, Dohrenwend MP, Moscinski LC. A case of the eosinophilia-myalgia syndrome associated with use of an L-tryptophan product . Ann Intern Med. 1990;112:300-301.Crossref 13. Travis WD, Kalafer ME, Robin HS, Luibel FJ. Hypersensitivity pneumonitis and pulmonary vasculitis with eosinophilia in a patient taking an L-tryptophan preparation . Ann Intern Med. 1990;112:301-303.Crossref 14. Kilbourne EM, Rigau-Perez JG, Heath CW, et al. Clinical epidemiology of toxic oil syndrome . N Engl J Med. 1983;309:1408-1414.Crossref 15. Tietz NW, ed. Clinical Guide to Laboratory Tests . Philadelphia, Pa: WB Saunders Co; 1983. 16. Swygert LA, Maes EF, Sewell LE, Miller L, Falk H, Kilbourne EM. Eosinophilia-myalgia syndrome: results of national surveillance . JAMA. 1990;264:1698-1703.Crossref 17. Kilbourne EM, Swygert LA, Philen RM, et al. Interim guidance on the eosinophilia myalgia syndrome . Ann Intern Med. 1990;112:85-87.Crossref 18. Grandjean P, Tarkowski S, eds. Toxic oil syndrome: mass food poisoning in Spain . In: Report of a WHO Meeting: Madrid 21-25 March 1983 . Copenhagen, Denmark: World Health Organization Regional Office for Europe; 1984:31-37. 19. Tabuenca JM. Toxic allergic syndrome caused by ingestion of rapeseed oil denatured with aniline . Lancet. 1981;2:567-568.Crossref 20. Toxic Epidemic Syndrome Study Group. Toxic epidemic syndrome: Spain 1981 . Lancet. 1982;2:697-702.Crossref 21. Blood DC, Henderson JA, Radostits OM, eds. Veterinary Medicine: A Textbook of the Diseases of Cattle, Sheep, Pigs, and Horses . 5th ed. Philadelphia, Pa: Lea & Febiger; 1979:1072-1077. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Eosinophilia-Myalgia Syndrome: A Clinical Case Series of 21 Patients

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400030083015
Publisher site
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Abstract

Abstract We reviewed 21 cases of eosinophilia-myalgia syndrome to describe the range of clinical findings in these patients. Most patients were women (20 [95%]) and middle-aged (mean, 46 years) and had taken the food supplement L-tryptophan (95%). All cases involved eosinophilia (eosinophil count, 2.0 × 109/L) and incapacitating myalgias. Fourteen (88%) of the 16 patients tested had mild liver function abnormalities. Aldolase levels were abnormal in all patients tested. Muscle biopsies were done in five patients; four showed eosinophilic perimyositis, and one had interstitial inflammation. No physical finding was pathognomonic or universal, but muscle tenderness, tachycardia, and rash were the most common signs found during physical examinations. Seven patients were treated with prednisone, and six showed improvement in muscle pain and a decrease in eosinophilia. The cause of this disorder is still unknown. (Arch Intern Med. 1991;151:533-537) References 1. Lakhanpal S, Duffy J, Engel AG. Eosinophilia associated with perimyositis and pneumonitis . Mayo Clin Proc. 1988;63:37-41.Crossref 2. Centers for Disease Control. Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States, as of January 9, 1990 . MMWR. 1990;39:14-15. 3. Eidson M, Philen RM, Sewell CM, Voorhees R, Kilbourne EM. L-Tryptophan and eosinophilia myalgia syndrome in New Mexico . Lancet. 1990;1:645-648.Crossref 4. Centers for Disease Control. Eosinophilia-myalgia syndrome—New Mexico . MMWR. 1989;38:765-767. 5. Centers for Disease Control. Eosinophilia-myalgia syndrome and L-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989 . MMWR. 1989;38:785-788. 6. Centers for Disease Control. Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States . MMWR. 1989;38:842-843. 7. Varga J, Peltonen J, Uitto J, Jimenez S. Development of diffuse fasciitis with eosinophilia during L-tryptophan treatment: demonstration of elevated type I collagen gene expression in affected tissues . Ann Intern Med. 1990;112:344-351.Crossref 8. Hertzman PA, Blevins WL, Mayer J, et al. Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan . N Engl J Med. 1990;322:869-873.Crossref 9. Silver RM, Heyes MP, Maize JC, et al. Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan . N Engl J Med. 1990;322:874-881.Crossref 10. Pfanner TP, Person DA, Berenberg JL, Gayle EL, Lockett LJ. Eosinophilia-myalgia syndrome associated with L-tryptophan . Lancet. 1990;1:353-354.Crossref 11. Amor B, Rajzbaum G, Poiraudeau S, Haas C, Kahan A. Eosinophiliamyalgia linked with L-tryptophan . Lancet. 1990;1:420.Crossref 12. Flannery MT, Wallach PM, Espinoza LR, Dohrenwend MP, Moscinski LC. A case of the eosinophilia-myalgia syndrome associated with use of an L-tryptophan product . Ann Intern Med. 1990;112:300-301.Crossref 13. Travis WD, Kalafer ME, Robin HS, Luibel FJ. Hypersensitivity pneumonitis and pulmonary vasculitis with eosinophilia in a patient taking an L-tryptophan preparation . Ann Intern Med. 1990;112:301-303.Crossref 14. Kilbourne EM, Rigau-Perez JG, Heath CW, et al. Clinical epidemiology of toxic oil syndrome . N Engl J Med. 1983;309:1408-1414.Crossref 15. Tietz NW, ed. Clinical Guide to Laboratory Tests . Philadelphia, Pa: WB Saunders Co; 1983. 16. Swygert LA, Maes EF, Sewell LE, Miller L, Falk H, Kilbourne EM. Eosinophilia-myalgia syndrome: results of national surveillance . JAMA. 1990;264:1698-1703.Crossref 17. Kilbourne EM, Swygert LA, Philen RM, et al. Interim guidance on the eosinophilia myalgia syndrome . Ann Intern Med. 1990;112:85-87.Crossref 18. Grandjean P, Tarkowski S, eds. Toxic oil syndrome: mass food poisoning in Spain . In: Report of a WHO Meeting: Madrid 21-25 March 1983 . Copenhagen, Denmark: World Health Organization Regional Office for Europe; 1984:31-37. 19. Tabuenca JM. Toxic allergic syndrome caused by ingestion of rapeseed oil denatured with aniline . Lancet. 1981;2:567-568.Crossref 20. Toxic Epidemic Syndrome Study Group. Toxic epidemic syndrome: Spain 1981 . Lancet. 1982;2:697-702.Crossref 21. Blood DC, Henderson JA, Radostits OM, eds. Veterinary Medicine: A Textbook of the Diseases of Cattle, Sheep, Pigs, and Horses . 5th ed. Philadelphia, Pa: Lea & Febiger; 1979:1072-1077.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1991

References