Tryptophan-associated eosinophilic connective-tissue disease. A new clinical entity?
D. J. Clauw, D. J. Nashel, A. Umhau and P. Katz
Georgetown University Medical Center, Division of Rheumatology, Immunology, and Allergy, Washington, DC 20007.
Seven patients who developed a syndrome of eosinophilia, connective-tissue
disease, and cutaneous abnormalities while ingesting tryptophan were
examined. Other clinical manifestations commonly seen were pulmonary
symptoms, fever, lymphadenopathy, and the development of myopathy.
Laboratory features included mild elevations of aldolase and lactate
dehydrogenase levels, with essentially normal creatine kinase levels,
erythrocyte sedimentation rates, and C-reactive protein levels. Biopsy
findings included features of scleroderma, small-vessel vasculitis,
fasciitis, and myopathy. Discontinuation of tryptophan administration and
implementation of corticosteroid therapy were of some benefit in relieving
the intense myalgias and cutaneous findings that developed. Although
temporally related to tryptophan ingestion, it is unclear whether this
substance, a metabolite, or a contaminant were causal. We speculate that
the pathogenesis of this syndrome may relate to abnormalities in tryptophan
metabolism.
