Eosinophilic fasciitis associated with tryptophan ingestion. A manifestation of eosinophilia-myalgia syndrome

Eosinophilia-myalgia syndrome presenting with overlapping features of eosinophilic fasciitis and sarcoidal granulomas

“…In 1991, it was suggested that many previously diagnosed cases of EF may have been variants of tryptophan-associated EMS. 7 Interestingly, our patient’s supplement did not contain L-tryptophan but instead had 5-HTP. There have been several reports of 5-HTP associated EMS.…”

Eosinophilic fasciitis with subjacent myositis

“…EF shares many clinical similarities with eosinophila‐myalgia syndrome and Spanish toxic oil syndrome from ingestion of contaminated L‐tryptophan and rapeseed oil (described later). In the latter 2 conditions, pulmonary involvement is more common than in cases of EF without a history of exposure to toxins, although previously these entities were thought to represent a clinical spectrum from a common disease process . In 1 of the larger case series of 52 EF patients, Lakhanpal et al .…”

A heretofore undisclosed crux of Eosinophilia-Myalgia Syndrome: compromised histamine degradation

“…Of eight examined subjects with L-tryptophan-induced EMS, four had elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) 16 long after discontinuing LTCDS use; tryptamine and indole-3-acetic acid (IAA) 17 levels appeared normal [97]. Compared to the minimal recommended daily intake of L-tryptophan (i. e., 200 mg day -1 [98]), typical Western diets contain approximately 1 g day -1 according to some reports [99]; others suggest this approximation is an underestimate [100,101].…”