A case of the eosinophilia-myalgia syndrome associated with use of an L-tryptophan product

Article Abstract:

L-tryptophan is used as a sedative hypnotic for the treatment of insomnia and as an antidepressant. This amino acid, a component of many proteins, is known to be toxic in large doses when taken as a dietary supplement. The effects of toxicity include nausea, vomiting, ataxia or uncoordinated movement, hyperreflexia or increase in reflex reactions, and possibly bladder cancer. Recent reports from the Centers for Disease Control showed a relationship between the use of L-tryptophan products and the development of the potentially fatal syndrome of eosinophilia-myalgia, where there are increased numbers of eosinophils, a type of white blood cell involved in inflammatory and allergic responses, and myalgia, muscle stiffness and pain. A case report is presented which also associates eosinophilia-myalgia with the use of an L-tryptophan product. When the L-tryptophan preparation was no longer used by the patient, the symptoms improved. When the patient resumed using the product, the eosinophilia and myalgia returned. Other complications from eosinophilia-myalgia syndrome can include skin changes, pulmonary hypertension, damage to peripheral nerves, thromboembolism, which is the blockage of blood vessels by a blood clot, and joint contractures. The Food and Drug Administration has advised the public not to take L-tryptophan products until this matter can be investigated further. It is thought that there may be a contaminant in the L-tryptophan products which is causing the eosinophilia-myalgia. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Development of diffuse fasciitis with eosinophilia during L-tryptophan treatment: demonstration of elevated type I collagen gene expression in affected tissues

Article Abstract:

Diffuse fasciitis involves the inflammation of the fascia, the fibrous membrane that covers, supports and separates muscles. The condition is characterized by the following abnormalities: thickening and hardening of the skin, the tissue underlying the skin, and the fascia; swelling of the extremities; and contraction of the joints. Diffuse fasciitis may be associated with the development of eosinophilia, the presence of an increased number of eosinophils, a type of white blood cell. The cause of diffuse fasciitis with eosinophilia is not known, although this disorder has been associated with heavy physical exertion. Four cases are described of women who developed this syndrome, which resembles scleroderma, after ingesting the amino acid L-tryptophan for treatment of insomnia or tinnitus, a ringing in the ears. The disease was characterized by swelling of the extremities, a skin rash, myalgia or muscle pain, increased eosinophils, and thickening and hardening of the skin and underlying tissue. Microscopic examination of the affected skin showed thickening of the fascia, fiber formation in the dermis, the inner skin layer, and accumulation of white blood cells. There was increased expression of the gene that controls the production of collagen, a fiber-like protein found in connective tissues such as skin, bone, ligaments, and cartilage. L-tryptophan and its breakdown products may be involved in causing this syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Genetic aspects, Collagen, Connective tissue diseases, Fasciae (Anatomy), Fasciitis

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Hypersensitivity pneumonitis and pulmonary vasculitis with eosinophilia in a patient taking an L-tryptophan preparation

Article Abstract:

L-tryptophan has been used for years as a sedative for the treatment of insomnia and as an antidepressant. L-tryptophan, a natural component of proteins, is toxic when taken as a dietary supplement in large doses. The toxic effects include nausea, vomiting, ataxia or uncoordinated movement, hyperreflexia or increase in reflex reactions, and possibly bladder cancer. A case is described of a patient who was taking L-tryptophan and developed hypersensitivity pneumonitis and pulmonary vasculitis, or swelling and infiltration of the lungs with white blood cells, a response that is commonly seen in allergic reactions. The hypersensitivity pneumonitis and pulmonary vasculitis were associated with eosinophilia, an increase in the number of eosinophils, white blood cells that are involved in inflammation and allergic reactions. Eosinophilia is commonly seen in drug-induced pneumonitis due to a hypersensitive allergic reaction. Recent reports have linked dietary intake of L-tryptophan products with the development of the potentially fatal syndrome of eosinophilia-myalgia, in which myalgia refers to muscle stiffness and pain. The Food and Drug Administration has removed L-tryptophan products from the market until this matter can be investigated further. It is possible that there may be a contaminant in the L-tryptophan products. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lung diseases, Vasculitis, Hypersensitivity pneumonitis, Extrinsic allergic alveolitis

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