title: Pulmonary manifestations of the eosinophilia-myalgia syndrome associated with tryptophan ingestion.
abstract: Pulmonary manifestations are not infrequent in the L-tryptophan-induced eosinophilia-myalgia syndrome (EMS). However, previous reports have not described the results of longitudinal pulmonary function, exercise testing, high-resolution computerized tomographic (HRCT) scanning of the chest, or detailed bronchoalveolar lavage (BAL) analysis. We report six patients with EMS who had dyspnea. The diffusing capacity for carbon monoxide was decreased in five patients tested. Exercise testing with arterial blood gas sampling in three patients was consistent with pulmonary vascular or parenchymal disease. Serial exercise testing in two of these patients demonstrated marked improvement temporally associated with corticosteroid treatment. In four patients, HRCT scanning of the chest was abnormal. One of these patients showed no abnormality on routine chest roentgenogram. Two patients undergoing BAL exhibited increased eosinophils in the lavage fluid; a third had elevated lymphocytes. Serial measurements of fibroblast proliferation-stimulating-activity in samples of BAL fluid obtained from serial examinations in two patients exhibited heightened pretreatment activity that returned to the normal range following corticosteroid therapy. In these two patients, increased proportions of T-suppressor/cytolytic (CD8+) cells were observed in the BAL fluid. Despite aggressive immunosuppressive therapy, one of the patients died of respiratory failure. Another remains markedly dyspneic with pulmonary hypertension. Of the remaining four patients, two exhibited resolution of pulmonary symptoms after systemic corticosteroid therapy, and two experienced partial improvement.
authors.affiliation: University of California, San Francisco, Division of Pulmonary and Critical Care Medicine.
authors.forename: A C
authors.initials: AC
authors.lastname: Campagna
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
authors.forename: L A
authors.initials: LA
authors.lastname: Criswell
authors.forename: D
authors.initials: D
authors.lastname: Clarke
authors.forename: K E
authors.initials: KE
authors.lastname: Sack
authors.forename: W M
authors.initials: WM
authors.lastname: Gold
authors.forename: J A
authors.initials: JA
authors.lastname: Golden
mesh_terms: D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D016603:Eosinophilia-Myalgia Syndrome / Q000139:chemically induced / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011653:Pulmonary Diffusing Capacity; D015656:Respiratory Mechanics; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014364:Tryptophan / Q000009:adverse effects
chemical_list: D014364:Tryptophan; D010100:Oxygen