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Eosinophilia-Myalgia Syndrome
Aka: Eosinophilia-Myalgia Syndrome- See Also
- Fibromyalgia
- Eosinophilia
- Hyperesoinophilic Syndrome
- Epidemiology
- Rare Condition associated with an unknown contaminant L-Tryptophan supplements from a single Tokyo manufacturer
- However case reports continue with L-Tryptophan and 5-Hydroxytryptophan (5-HTP) supplement use
- Ultimately >1500 confirmed cases (actual numbers estimated at 5,000-10,000) and resulted in 37 deaths
- Gender: Women were most often affected
- U.S. had most reported cases, but
- Rare Condition associated with an unknown contaminant L-Tryptophan supplements from a single Tokyo manufacturer
- History
- First described in 1989 in New Mexico and Minnesota
- Associated with L-Tryptophan and 5-Hydroxytryptophan (5-HTP) supplement use
- Resulted in a U.S. recall of L-Tryptophan supplements in 1989
- Associated Conditions
- Pathophysiology
- Linked to L-Tryptophan and 5-Hydroxytryptophan (5-HTP) usage
- Suspected cause is an unknown contaminant in the supplements
- Symptoms
- Myalgias (Uniformly present)
- Rapid onset with persistent pain
- Severe and incapacitating pain (limits Activities of Daily Living)
- Associated with muscle spasms (esp. calves, Abdomen)
- Associated with perceived weakness
- Exacerbated by movement
- Arthralgias (73%)
- Pruritus
- Non-productive cough with Dyspnea (59%)
- Neuropathy (27%)
- Paresthesia or Hypesthesia (e.g. Burning sensation)
- Myalgias (Uniformly present)
- Signs
- Rash (60%)
- Peripheral Edema (59%)
- Cutaneous non-Pitting Edema
- Periorbital edema (28%)
- Fever (36%)
- Alopecia (28%)
- Hepatomegaly (5%)
- Thickened skin (32%)
- Labs
- Complete Blood Count (CBC)
- Elevated Peripheral Eosinophil Count
- Leukocytosis (85%)
- Aldolase increase (46%)
- Creatine Kinase increase (10%)
- Erythrocyte Sedimentation Rate (ESR) increased (33%)
- Liver Function Test (LFT) abnormality (43%)
- Antinuclear Antibody (ANA) frequently positive
- Speckled pattern most common
- Complete Blood Count (CBC)
- Radiology: Chest XRay findings
- Infiltrates (17%)
- Pleural Effusions (12%)
- Differential Diagnosis
- See Eosinophilia
- Polymyositis
- Polymyalgia Rheumatica
- Trichinosis
- Polyarteritis Nodosa
- Churg Strauss
- Systemic Sclerosis
- Hypereosinophilic Syndrome
- Diagnosis: Criteria from CDC Cases
- Peripheral Eosinophil Count >1000 cells/mm
- Severe myalgias that interfere with daily activity
- Exclude other diagnoses
- Infection
- Neoplastic Disease
- Other diagnosis responsible
- Management
- General Therapies
- Systemic Corticosteroids
- Not uniformly effective
- Unlikely effective if no response by 4-6 weeks
- Predictors of response
- High doses are required initially
- Other experimental therapies
- Methotrexate
- Vitamin B6
- Cyclosporine
- Cyclophosphamide
- Plasmapheresis
- Systemic Corticosteroids
- Myalgias and Muscle spasms (very difficult to treat)
- Quinine sulfate
- Tricyclic Antidepressants
- Methocarbamol
- Cyclobenzaprine
- Dantrolene
- Baclofen
- Benzodiazepines
- Narcotics Analgesics may be needed
- Chronic Pain Management
- General Therapies
- Resources
- Eosinophilia-Myalgia Syndrome (NIH)
- Reference
- Freundlich in Kelley (1993), Textbook Rheumatology, Saunders, Philadelphia, p. 1150-7
- Hertzman (1995) J Rheumatol 22(1):161-3 [PubMed]
- Swygart (1990) JAMA 264:1698-1703 [PubMed]