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A New Clinical Entity?

Daniel J. Clauw, MD; David J. Nashel, MD; Andrew Umhau, MD; Paul Katz, MD

JAMA. 1990;263(11):1502-1506.

Abstract
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.

(JAMA. 1990;263:1502-1506)

Author Affiliations
From the Georgetown University Medical Center (Drs Clauw, Umhau, and Katz) and the Veterans Administration Medical Center (Dr Nashel), Washington, DC.

Footnotes
Reprint requests to Division of Rheumatology, Immunology, and Allergy, Georgetown University Medical Center, Lower Level Gorman Bldg, 3800 Reservoir Rd NW, Washington, DC 20007 (Dr Clauw).

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