The eosinophilia-myalgia syndrome

Abstract

A seemingly new illness was first described in the United States in late 1989, when physicians in New Mexico reported the occurrence #of generalized myalgia and eosinophilia in three women, each of whom had a prior history of ingesting the amino acid, L-tryptophan.’ The illness, which has been linked to the ingestion of L-tryptophan containing trace amounts of chemical contaminants reached epidemic proportions in late 1989, and it quickly subsided when L-tryptophan containing products were recalled. This illness, now known as the eosinophilia -myalgia syndrome (EMS), was frequently complicated by the occurrence of sclerodermalike hardening of the skin and subcutaneous tissues and, thus, may be added to a growing list of environmental or toxin exposures implicated in the pathogenesis of sclerodermatous disorders. EMS shares many features with diffuse fasciitis with eosinophilia (DFE or Shulman’s disease),2 as well as with the toxic oil syndrome (TOS), another sclerodermalike disease which occurred as an epidemic in 1981, affecting nearly 20,000 individuals in Spain.3 The study of EMS and related conditions is important, not only for the sake of public health, but also for the insight which may be gained for better understanding of systemic sclerosis (SSc) and other fibrosing cutaneous processes.