Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano

Abstract

Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80% of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.

Risk Assessment of "Other Substances" – Conjugated Linoleic Acids

“…Some infiltration of eosinophils and neutrophils were found in reticular dermis and septa of the paniculus. In the two case reports with patients one women was found with eosinophilia in the lungs (Grangeia et al, 2007) and one in lungs and muscles (Allen et al, 2011) after short periods of supplementation with tryptophan. Although both women had used tryptophan supplementation in combination with other substances, tryptophan was the common substance and indicated as the causal substance in both reports.…”

“…In the literature search, five studies in humans were identified after 2002. One study was a study with tryptophan loading among 15 men, age 21-56 years (Forrest et al, 2004), three reports were case reports (Allen et al, 2011;Grangeia et al, 2007;Noakes et al, 2006), one study was an epidemiological study from Japan (Okada et al, 2009).…”

“…The results indicate that the tryptophan quinolinic acid might be responsible for eosinophilic fasciitis Grangeia et al, 2007 Case report Tryptophan (2g/d) Case-report 1500 mg of L-tryptophan for 3 weeks Blood count, biopsy 1 The women were diagnosed with EMS. In spite of treatment with cortisone the symptoms did not resolve in spite of reduced eosinophilia.…”