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Claude O. Burdick, MD; Richard Lutz, MD; Scott Bowman, MD
Valley Memorial Hospital Livermore, Calif

JAMA. 1990;264(8):969.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Dr Lahmeyer's¹ response to an inquiry on the safety of tryptophan use doubtless was prepared prior to the recent cases of tryptophaninduced hypereosinophilia syndrome (San Francisco Chronicle. November 14, 1989:3). One can be certain he would now upgrade his "lack of enthusiasm" to condemnation. During the present epidemic we have seen five cases. One was a woman who took 1500 mg/d of tryptophan along with 150 mg/d of amitriptyline. She entered the hospital with congestive heart failure, joint pains, and a headache. Her peripheral leukocyte count was 43 x 10⁹/L and showed 0.80 eosinophils, of which 12% had three or four lobes, a finding that does not usually occur except under the stress of folate or B₁₂ deficiency.² Our patient's folate level was 9.9 nmol/L (4.1 to 20.4 nmol/L), and her B₁₂ level was 697 pmol/L (74 to 516 pmol/L), values that . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Don Riesenberg, MD, Senior Editor.

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