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James I. Hudson, MD; Harrison G. Pope, Jr, MD, MPH
Harvard Medical School/McLean Hospital Belmont, Mass

Stephen R. Daniels, MD, PhD
University of Cincinnati (Ohio) College of Medicine

Ralph I. Horwitz, MD
Yale University School of Medicine New Haven, Conn

JAMA. 1993;269(24):3108.

	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.

—Eosinophilia-myalgia syndrome (EMS) is a newly described clinical entity characterized by severe myalgia and peripheral eosinophilia. Several studies^1,2 have suggested that EMS may be associated with the use of the amino acid tryptophan, prompting many countries to withdraw tryptophan from the market. However, the role of tryptophan in the pathophysiology of EMS remains clouded by possible confounding variables, as suggested by the following case.

Report of a Case.

—A 43-year-old woman presented with EMS meeting the Centers for Disease Control and Prevention (CDC) case definition¹; that is, she displayed (1) a peripheral eosinophil count of at least 1.0x10⁹/L (in this case, 5.0x10⁹/L); (2) generalized myalgia severe enough to affect her ability to pursue usual daily activities; and (3) no evidence of any infection or neoplasm that could account for the first and second features. She had been taking tryptophan since . . . [Full Text PDF of this Article]

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