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Digestive Diseases and Sciences

, Volume 37, Issue 5, pp 697–701 | Cite as

Gastrointestinal involvement inl-tryptophan (l-trp) associated eosinophilia-myalgia syndrome (EMS)

  • K. De Schryver-Kecskemeti
  • K. W. Bennert
  • G. S. Cooper
  • P. Yang
Case Report

Summary

We report a 45-year-old female who had symptomatic gastrointestinal involvement, eosinophils in the cellular infiltrate, and who proved to havel-tryptophan-associated eosinophilia-myalgia syndrome. This case illustrates that gastrointestinal disease can be a major, seemingly primary clinical presentation in this syndrome, and that a drug history, specificallyl-tryptophan, needs to be included in the differential diagnosis of “eosinophilic gastroenteritis.”

Key Words

l-tryptophan gastrointestinal disease eosinophils eosinophila myalgia syndrome 

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References

  1. 1.
    Eosinophilia-myalgia syndrome andl-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989. MMWR 38:785–788, 1989Google Scholar
  2. 2.
    Kilbourne EM, Swygert LA, Philen RM, Sun RK, Auerbach SB, Miller L, Nelson DE, Falk H: Interim guidance on the eosinophilic-myalgia syndrome. Ann Int Med 112:85–87, 1990 (editorial)Google Scholar
  3. 3.
    Hertzman PA, Blevins WL, Mayer, J, Greenfield B, Ting M, Gleich GJ: Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan. N Engl J Med 322:869–873, 1990Google Scholar
  4. 4.
    Varga J, Heinman-Patterson TD, Emery DL, Griffin R, Lally EV, Uitto JJ, Jimenez SA: Clinical spectrum of the systemic manifestations of the eosinophilia-myalgia syndrome: Semin Arthritis Rheum 19:313–328, 1990Google Scholar
  5. 5.
    Hsu SM, Raine L, Fanger H: Use of avidin-biotinperoxidase complex (ABC) in immunoperoxidase techniques: A comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 29:577–580, 1981Google Scholar
  6. 6.
    Tai PC, Spry CJ, Peterson C, Venge P, Olsson T: Monoclonal antibodies distinguish between storage and secreted forms of eosinophil cationic protein. Nature 309:182–184, 1984Google Scholar
  7. 7.
    Update: Eosinophilia myalgia associated with ingestion ofl-tryptophan—United States, as of January 9, 1990. JAMA 265:633, 1990Google Scholar
  8. 8.
    Madara JL, Carlson S: Supraphysiologicl-tryptophan elicits cytoskeletal and macromolecular permeability alterations in hamster small intestinal epitheliumin vitro. J Clin Invest 87:454–462, 1991Google Scholar
  9. 9.
    De Schryver-Kecskemeti K, Gramlich TL, Crofford LJ, Rader JI, Page SW, Needham LL, Hill RH Jr, Sternberg EM: Mast cell and eosinophil infiltrates in gastrointestinal mucosa of Lewis rats treated withl-tryptophan implicated in human eosinophilia myalgia syndrome. Modern Pathol 4:354–357, 1991Google Scholar
  10. 10.
    Varga J, Peltonen J, Uitto J, Jimenez SA: Development of diffuse fasciitis with eosinophilia duringl-tryptophan treatment: Demonstration of elevated type I collagen gene expression in affected tissues (A clinicopathologic study of four patients). Ann Intern Med 112:344–351, 1990Google Scholar
  11. 11.
    Clauw DJ, Danshel DJ, Umhau A, Katz P: Tryptophanassociated eosinophilic connective-tissue disease (a new clinical entity?) JAMA 263:1502–1506, 1990Google Scholar
  12. 12.
    Owen WF, Petersen J, Sheff DM, Folkerth RD, Anderson RJ, Corson JM, Sheffer AL, Austen KF: Hypodense eosinophils and interleukin 5 activity in the blood of patients with the eosinophilia-myalgia syndrome. Proc Natl Acad Sci USA 87:8647–8651, 1990Google Scholar
  13. 13.
    Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR: Eosinophilic gastroenteritis: A clinical pathological study of patients with disease of the mucosa, muscle layer and subserosal tissues. Gut 31:54–58, 1990Google Scholar
  14. 14.
    De Schryver-Kecskemeti K, Clouse RE: A previously unrecognized subgroup of “eosinophilic gastroenteritis”: That associated with connective tissue disease. Am J Surg Pathol 8:171–180, 1984Google Scholar
  15. 15.
    Case records of the Massachusetts General Hospital (Case 4-1990). N Engl J Med 322:252–261, 1990Google Scholar
  16. 16.
    Freundlich B, Werth VP, Rook AH, O'Connor CR, Schumacher HR, Leyden JJ, Stolley PD:l-tryptophan ingestion associated with eosinophilic fasciitis but not progressive systemic sclerosis. Ann Intern Med 112:758–762, 1990Google Scholar
  17. 17.
    Gordon ML, Lebwohl MG, Phelps RG, Cohen SR, Fleischmajer R: Eosinophilic fasciitis associated with tryptophan ingestion. Arch Dermatol 127:217–220, 1991Google Scholar
  18. 18.
    Varga J, Griffin R, Newman JH, Jimenez SA: Eosinophilic fasciitis is clinically distinguishable from the eosinophiliamyalgia syndrome and is not associated withl-tryptophan use. J Rheumatol 19:259–263, 1991Google Scholar
  19. 19.
    Kilbourne EM, Rigau-Perez JG, Heath CW Jr, Zack MM, Falk H, Martin-Marcos M, de Carlos A: Clinical epidemiology of toxic-oil syndrome: Manifestation of a new illness. N Engl J Med 309:1408–1414, 1983Google Scholar
  20. 20.
    Bern MJ, Sturbaum CW, Karayalcin SS, Berschneider HM, Wachsman JT, Powell DW: Immune system control of rat and rabbit colonic electrolyte transport: Role of prostaglandins and enteric nervous system. J Clin Invest 83:1810–1820, 1989Google Scholar
  21. 21.
    Perdue MH, Chung M, Gall DG: Effect of intestinal anaphylaxis on gut function in the rat. Gastroenterology 86:391–397, 1984Google Scholar
  22. 22.
    De Schryver-Kecskemeti K, Clouse RE: Perineural/intraneural inflammatory infiltrates in the intestines of patients with systemic connective tissue disease. Arch Pathol Lab Med 113:394–398, 1989Google Scholar
  23. 23.
    Cohen S, Laufer I, Snape WJ, Yih-Ju S, Levine GM, Jimens S: The gastrointestinal manifestations of scleroderma: Pathogenesis and management. Gastroenterology 79:155–166, 1980Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • K. De Schryver-Kecskemeti
    • 1
    • 2
  • K. W. Bennert
    • 1
    • 2
  • G. S. Cooper
    • 1
    • 2
  • P. Yang
    • 1
    • 2
  1. 1.Department of PathologyCase Western Reserve University School of MedicineCleveland
  2. 2.Department of MedicineCase Western Reserve University School of MedicineCleveland

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