title: Demyelinating polyneuropathy in eosinophilia-myalgia syndrome.
abstract: Eosinophilia-myalgia syndrome (EMS) is a newly recognized disorder, characterized by myalgia, weakness, scleroderma-like changes, and eosinophilia. EMS is associated with lots of L-tryptophan allegedly contaminated with byproducts of the manufacturing process. We describe 3 patients with EMS who presented with a severe demyelinating sensorimotor polyneuropathy. Electrodiagnostic studies revealed multifocal conduction block, slowing and temporal dispersion of motor responses, and prolonged or absent F-responses. Despite plasmapheresis; corticosteroids; and, in 1 patient, cyclophosphamide, 2 patients died and the remaining patient experienced minimal recovery. Pathology revealed patchy perivascular infiltrates and fibrosis in the connective tissue of muscle and nerve. Autopsy of the central nervous system in 2 patients did not reveal changes unique to EMS. In addition to other organ involvement, EMS may manifest as a potentially fatal polyneuropathy, which initially appears to have prominent demyelinating features.
authors.affiliation: Department of Neurology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1078.
authors.forename: P D
authors.initials: PD
authors.lastname: Donofrio
authors.forename: C
authors.initials: C
authors.lastname: Stanton
authors.forename: V S
authors.initials: VS
authors.lastname: Miller
authors.forename: L
authors.initials: L
authors.lastname: Oestreich
authors.forename: D S
authors.initials: DS
authors.lastname: Lefkowitz
authors.forename: F O
authors.initials: FO
authors.lastname: Walker
authors.forename: E W
authors.initials: EW
authors.lastname: Ely
mesh_terms: D003711:Demyelinating Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016603:Eosinophilia-Myalgia Syndrome / Q000139:chemically induced / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009431:Neural Conduction / Q000502:physiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014364:Tryptophan / Q000009:adverse effects*
chemical_list: D014364:Tryptophan