A Case of the Eosinophilia-Myalgia Syndrome Associated with Use of an L-Tryptophan Product
Authors: Michael T. Flannery
Journal: Annals of Internal Medicine (1990)

Brief Reports15 February 1990A Case of the Eosinophilia-Myalgia Syndrome Associated with Use of an L-Tryptophan ProductMichael T. Flannery, MD, Paul M. Wallach, MD, Luis R. Espinoza, MD, Michael P. Dohrenwend, MD, Lynn C. Moscinski, MDMichael T. Flannery, MDSearch for more papers by this author, Paul M. Wallach, MDSearch for more papers by this author, Luis R. Espinoza, MDSearch for more papers by this author, Michael P. Dohrenwend, MDSearch for more papers by this author, Lynn C. Moscinski, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-4-300 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptL-Tryptophan has been used as a sedative hypnotic for insomnia and as an antidepressant for many years. Previously reported toxicity has included nausea, vomiting, ataxia, hyperreflexia, possibly metabolite-induced bladder carcinogenesis, and worsening of hepatic encephalopathy in patients with a portocaval shunt (1, 2). Recent reports from the Centers for Disease Control (3, 4) indicate that there may be an association between the use of L-tryptophan products and development of a syndrome of myalgias and eosinophilia. We report a case of the eosinophilia-myalgia syndrome without other known causes of eosinophilia and associated with use of an L-tryptophan product. When L-tryptophan was...References1. L-Tryptophan—a "natural" sedative? Med Lett Drugs Ther. 1977;19:108. MedlineGoogle Scholar2. Ogihara K, Mozai T, and Hiral S. Tryptophan as cause of hepatic coma. N Engl J Med. 1966;275:1255-6. CrossrefMedlineGoogle Scholar3. Eosinophilia-myalgia syndrome—New Mexico. MMWR. 1989; 38:765-7. MedlineGoogle Scholar4. Eosinophilia-myalgia syndrome and L-tryptophan-containing products-New Mexico, Minnesota, Oregon, and New York, 1989. 1989;38:785-8. Google Scholar5. Trichinosis surveillance, United States, 1986. MMWR. 1988;37:1-8. MedlineGoogle Scholar6. Doyle J and Ginsburg W. Eosinophilic fasciitis. Med Clin North Am. 1989;73:1157-66. CrossrefMedlineGoogle Scholar7. Jameson M and Segraves S. Idiopathic hypereosinophilic syndrome. Postgrad Med. 1988;84:93-6, 101. CrossrefMedlineGoogle Scholar8. Fauci A, Harley J, and Roberts W. NIH conference. The idiopathic hypereosinophilic syndrome. Clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med. 1982;97:78-92. LinkGoogle Scholar9. Kilbourne E, Rigau-Perez J, and Heath C. Clinical epidemiology of toxic-oil syndrome. N Engl J Med. 1983;309:1408-14. CrossrefMedlineGoogle Scholar10. Toxic epidemic syndrome, Spain, 1981. Toxic Epidemic Syndrome Study Group. Lancet. 1982;2:697-702. MedlineGoogle Scholar11. Kilbourne E, Swygert L, and Philen R. Interim guidance on the eosinophilia-myalgia syndrome [Editorial]. Ann Intern Med. 1990;112:85-7. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Michael T. Flannery, MD; Paul M. Wallach, MD; Luis R. Espinoza, MD; Michael P. Dohrenwend, MD; Lynn C. Moscinski, MDFrom the University of South Florida College of Medicine, Tampa, Florida. For current author addresses, see end of text. 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