title: [Two cases of L-tryptophan ingestion induced eosinophilia-myalgia syndrome].
abstract: Eosinophilia-myalgia syndrome (EMS), a new connective tissue disease was reported and named in 1989 from New Mexico, U.S.A. L-tryptophan has been suspected as the causative agent of EMS. This L-tryptophan was made in Japan, but no definite case of EMS has been reported in Japan. We report 2 patients with EMS. A 72-year-old woman and a 74-year-old woman, who had been treated with oral L-tryptophan 1 g/day for 4 and 5 months by the same doctor simultaneously. The clinical courses of the two cases were similar. A diffuse erythema and swelling appeared on the arms and spread over the whole body. The skin lesions turned into lustrous sclerosis. Eosinophilia was remarkable in the early stage. ANA, DNA anti-body and ENA antibodies were all negative. Neurological examination revealed a mild peripheral neuropathy. No sclerodactylia and no Raynaud's phenomenon in our cases are characteristic findings in EMS. The simultaneous onset of two cases using the same drug at the same time implicates the close relation of L-tryptophan ingestion to EMS.
authors.affiliation: Department of Dermatology, Mie University School of Medicine.
authors.forename: T
authors.initials: T
authors.lastname: Mizutani
authors.forename: H
authors.initials: H
authors.lastname: Mizutani
authors.forename: K
authors.initials: K
authors.lastname: Hashimoto
authors.forename: M
authors.initials: M
authors.lastname: Kishida
authors.forename: H
authors.initials: H
authors.lastname: Taniguchi
authors.forename: H
authors.initials: H
authors.lastname: Okada
authors.forename: M
authors.initials: M
authors.lastname: Murata
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: M
authors.initials: M
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D004802:Eosinophilia / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D008854:Microscopy, Electron; D009135:Muscular Diseases / Q000139:chemically induced* / Q000473:pathology; D010146:Pain / Q000139:chemically induced* / Q000473:pathology; D010525:Peripheral Nerves / Q000187:drug effects / Q000648:ultrastructure; D012867:Skin / Q000294:innervation / Q000473:pathology*; D013577:Syndrome; D014364:Tryptophan / Q000009:adverse effects*
chemical_list: D014364:Tryptophan