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Analysis of Four Patients and Implications for Differential Diagnosis and Pathogenesis

Steven L. Strongwater, MD; Bruce A. Woda, MD; Robert A. Yood, MD; Mary Ellen Rybak, MD; Jane Sargent, MD; Umberto DeGirolami, MD; Thomas W. Smith, MD; Charlene Varnis, MD; Scott Allen, MD; Kevin Murphy, MD; Rajwant Malhotra; Paul L. Romain, MD

Arch Intern Med. 1990;150(10):2178-2186.

Abstract
• Four patients fulfilling the case definition for eosinophiliamyalgia syndrome are described, including one whose disease began in 1986. Each displayed a variety of symptoms: one suffered principally from myalgia and recovered spontaneously on discontinuation of L-tryptophan therapy; one exhibited progressive sclerodermiform skin changes, neuropathy, and myopathy; a third had prominent neuromuscular disease and sclerodermiform skin changes; and the fourth experienced profound weight loss, an axonal polyneuropathy, and perivascular lymphoid infiltrates simulating a lymphoma. Evidence of T-cell activation was present in peripheral blood and affected tissues during the clinically active progressive phase of disease. Among other manifestations pleural effusion, cutaneous vasculitis, joint contractures, and bloody diarrhea were observed. A history of L-tryptophan ingestion should be sought in patients with myalgia, fatigue, or the above outlined symptoms.

(Arch Intern Med. 1990;150:2178-2186)

Author Affiliations
From Divisions of Rheumatology and Immunology (Drs Strongwater, Varnis, and Romain), Hematology (Dr Rybak), General Medicine (Dr Allen), and Gastroenterology (Dr Murphy), Department of Medicine, and Departments of Neurology (Dr Sargent) and Pathology (Drs Woda, DeGirolami, Smith, and Malhotra), University of Massachusetts Medical Center, Worcester; and Departments of Medicine, Saint Vincent Hospital, and Fallon Clinic, Worcester, Mass (Dr Yood).

Footnotes
Accepted for publication April 30,1990.

Reprint requests to Division of Rheumatology and Immunology, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655 (Dr Strongwater).

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