Central European Journal of Medicine

, Volume 9, Issue 6, pp 796–801 | Cite as

Eosinophilia-myalgia syndrome induced by excessive L-tryptophan intake from cashew nuts

  • Marko Barešić
  • Dubravka Bosnić
  • Marija Bakula
  • Kamelija Žarković
Case Report


Eosinophilia is characterized by more than 0.5 × 109 eosinophils per liter in the full blood count. A wide range of conditions, from asthma to parasitic infections, autoimmune diseases, and certain forms of cancer, have been known to trigger abnormally high amount of eosinophils. It is essential to reach the correct diagnosis and treat the underlying disease aggresively. Definition of the eosinophilia-myalgia syndrome was offered in 1980s by Centers for Disease Control and Prevention for surveillance purposes, and criteria were revised in 2001, with high specificity. We report a case of 59-year old female who started a special weight-reducing diet regimen that included excessive cashew nut ingestion. Several months after she has presented with periferal blood eosinophilia and constitutional symptoms. Detailed work-up has not found elements for haematological, systemic autoimmune, neoplastic or infectious disease. She was diagnosed with eosinophilia-myalgia syndrome due to extreme L-tryptophan intake, a compound found in the cashew nut’s oil. She responded well to cashew nut withdrawal and steroid therapy. In the follow-up period she remained stable with normal eosinophil count and there was not a need for any specific therapy.


Hypereosinophilic syndrome Eosinophilia-myalgia syndrome L-tryptophan Cashew nuts 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Holland SM, Gallin JI. Disorders of Granulocytes and Monocytes. In: Fauci AS et al. [ed.] Harrison’s Principles of Internal Medicine, ed. 17. New York, McGraw-Hill Companies, 2008:383Google Scholar
  2. [2]
    Medsger, T.A. Eosinophilia-myalgia syndrome. In Medscape Reference [online]. Available at:
  3. [3]
    Gotlib J. Eosinophilic disorders: Molecular pathogenesis, new classification and mofern therapy. Best practice & Reasearch Clinical Haematology. 2006;19(3):535–569CrossRefGoogle Scholar
  4. [4]
    Allen J.A., Paterson A., Sufit R., et al. Postepidemic eosinophilia-myalgia syndrome associated with L-tryptopan. Arthritis & Rheumatism. 2011; 63(11) 3633–3639CrossRefGoogle Scholar
  5. [5]
    de Araujo Guerra Grangeia T, Schweller M, Aparecida Paschoal I, et al. Acute respiratory failure as a manifestation of eosinophilia-myalgia syndrome associated with L-tryptophan intake. J Bras Pulmol. 2007;33(6):747–751CrossRefGoogle Scholar
  6. [6]
    Noakes R, Spelman L, Williamsom R. Is the L-tryptophan metabolite quinolonic acid responsable for eosinophilic fasciitis? Clin Exp Med. 2006; 6:60–64PubMedCrossRefGoogle Scholar
  7. [7]
    Hertzman PA, Clauw DJ, Duffy J. Rigorous new approach to constructing a gold standard for validating new diagnostic criteria, as exemplified by eosinohilia-myalgia syndrome. Ann Intern Med. 2001; 161: 2301–2306CrossRefGoogle Scholar
  8. [8]
    Dinic-Uzurov V, Lalosevic V, Milosevic I, et al. [Current differential diagnosis of hypereosinophilic syndrome] Med Pregl. 2007:LX(11–12):581–586CrossRefGoogle Scholar
  9. [9]
    Petterson R, Germolec D. Toxic Oli Syndrome: Review of immune aspects of the disease. J of Immunotoxicology. 2005;2(1):51–58CrossRefGoogle Scholar
  10. [10]
    Liss M. Eosinophilia. In Medscape Reference [online]. Available at:

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Marko Barešić
    • 1
  • Dubravka Bosnić
    • 1
  • Marija Bakula
    • 1
  • Kamelija Žarković
    • 1
  1. 1.University Hospital Center ZagrebZagrebCroatia

Personalised recommendations