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Case Report
Post-epidemic eosinophilia–myalgia syndrome associated with L-tryptophan
Article first published online: 28 OCT 2011
DOI: 10.1002/art.30514
Copyright © 2011 by the American College of Rheumatology
Additional Information
How to Cite
Allen, J. A., Peterson, A., Sufit, R., Hinchcliff, M. E., Mahoney, J. M., Wood, T. A., Miller, F. W., Whitfield, M. L. and Varga, J. (2011), Post-epidemic eosinophilia–myalgia syndrome associated with L-tryptophan. Arthritis & Rheumatism, 63: 3633–3639. doi: 10.1002/art.30514
Publication History
- Issue published online: 28 OCT 2011
- Article first published online: 28 OCT 2011
- Accepted manuscript online: 23 JUN 2011 02:57PM EST
- Manuscript Accepted: 16 JUN 2011
- Manuscript Received: 10 FEB 2011
Funded by
- Scleroderma Research Foundation
- Arthritis Foundation
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: U01-AR-055063
- National Human Genome Research Institute. Grant Number: R01-HG-004499
- National Cancer Institute. Grant Numbers: R01-CA-077485, R25-CA-134286
- NIH (National Institute of Environmental Health Sciences). Grant Numbers: Z01-ES-101074-DIR, AR-42309
Abstract
Eosinophilia–myalgia syndrome (EMS) is characterized by subacute onset of myalgias and peripheral eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to consumption of L-tryptophan that had originated from a single source. Following the ban by the Food and Drug Administration (FDA) on the sale of L-tryptophan, the incidence of EMS declined rapidly. Moreover, no new cases have been described since the FDA ban was lifted in 2005. We report the clinical, histopathologic, and immunogenetic features of a new case of L-tryptophan–associated EMS, along with evidence of activated transforming growth factor β and interleukin-4 signaling in the lesional skin.