Myalgia and Eosinophilia Associated With Ingestion of Tryptophan

Abstract

The delineation of a new syndrome associated with an identifiable etiology raises a series of nosologic questions. Issues of particular interest are the clinical overlap with known and well-recognized syndromes, the extent of previous misdiagnosis, and the relationship of the pathogenesis of the new syndrome to that of clinically similar diseases. See also p 2186 and p 2197. In the latter part of 1989, it was reported 1,2 that dietary supplementation with tryptophan may give rise to a syndrome including myalgia, peripheral edema, and induration of the skin. This is associated with peripheral blood eosinophilia and accumulation of eosinophils with other inflammatory cells around small blood vessels in some of the involved tissues. The new eosinophilia-myalgia syndrome (EMS) is also associated with a peripheral neuropathy, which may ascend and cause fatal respiratory failure. The affected patients with EMS had ingested tryptophan in doses averaging 1.5 g daily as a nostrum