Polymyositis in Eosinophilic Fasciitis

Bjelle, A; Henriksson, K. G.; Hofer, Per‐Åke

doi:10.1159/000115137

Cited by 20 publications

(2 citation statements)

References 11 publications

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“…The inflammatory changes in the fascia are often also seen in the part of the muscle adjacent to the fascia but the full clinical picture of PM is rare. We have seen one patient with eosinophilic fasciitis and PM, (Bjelle et al, 1980). This patient had perifascicular atrophy in his muscle biopsya finding which is considered almost pathognomic for PM.…”

Section: Associated Diseasesmentioning

confidence: 88%

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Recent Advances in Investigation of Polymyositis

Henriksson

1980

Acta Neurologica Scandinavica

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Section: Associated Diseasesmentioning

confidence: 88%

“…Indurative changes are found in the skin which is bound down to the fascia. We have seen one patient with eosinophilic fasciitis and PM, (Bjelle et al, 1980). Flexion contractures develop.…”

Section: Associated Diseasesmentioning

confidence: 95%

Recent Advances in Investigation of Polymyositis

Henriksson

1980

Acta Neurologica Scandinavica

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Orthopedic surgery

1983

Arthritis & Rheumatism

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Association of l‐tryptophan and an illness resembling eosinophilic fasciitis: clinical and histopathologic findings in four patients with eosinophilia‐myalgia syndrome

Bulpitt

Verity

Clements

et al. 1990

Arthritis & Rheumatism

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The Centers for Disease Control has recently reported an association between the use of oral Ltryptophan preparations and a disease marked by severe myalgia, peripheral eosinophilia, and neuromuscular and cutaneous abnormalities. They have labeled the condition eosinophilia-myalgia syndrome. We report here the clinical and histopathologic findings in 4 patients who developed an illness resembling eosinophilic fasciitis following the initiation of oral L-tryptophan supplementation.L-tryptophan has gained popularity as an empiric therapy for a variety of pain and sleep disorders, including insomnia, premenstrual syndrome, fibromyalgia (11, and depression. and over the last decade, its recommendation by practitioners and use by the general public have become extensive. Recently. the Centers for Disease Control (CDC) has received numerous reports suggesting a possible relationship between the oral consumption of commercial preparations of I>-tryptophan and the development of a syndrome marked by eosinophilia. severe myalgia, fever, skin changes, and respiratory symptoms, with onset weeks to years after initiation of L-tryptophan use ( 2 4 ) . The CDC has issued a health alert advising consumers to discontinue the use of this dietary supplement. They provided a provisional case-definition of eosinophilia-myalgia syndrome (EMS), but they did not include definitive morphologic findings. The precise role of L-tryptophan (or a contaminant in the L-tryptophan preparation) in the development of the syndrome is unknown, but the temporal relationship between the use of these preparations and the onset of EMS was sufficient to warrant this immediate warning by the CDC.Eosinophilic fasciitis (EF) was originally described by Shulman in 1974 ( 5 ) and further characterized by Rodnan and coworkers the following year (6,7). Although recognizing a similarity between EF and idiopathic scleroderma, Rodnan and other investigators have postulated that EF is a clinically distinct entity, differentiated from scleroderma by the pattern and appearance of the skin involvement, the presence of eosinophilia, the absence of Raynaud's phenomenon, an elevation in the erythrocyte sedimentation rate (ESR) and gamma globulin level, the rapidity with which contractures develop, the responsiveness to corticosteroid treatment, and the characteristic biopsy findings of deep fasciitis with perivascular infiltrates sparing skin and muscle. Over 200 case reports have followed the original description; however, the etiology of EF has remained an enigma.In this report, we describe 4 patients whose clinical and laboratory findings fit the CDC's provisional criteria for the diagnosis of EMS and who developed an illness that clinically resembled eosinophilic fasciitis. In response to the CDC's health alert, their cases were retrospectively reviewed and it was discovered that all 4 were taking L-tryptophan before and during the disease course. This probable associa-

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Polymyositis in Eosinophilic Fasciitis

Cited by 20 publications

References 11 publications

Recent Advances in Investigation of Polymyositis

Recent Advances in Investigation of Polymyositis

Orthopedic surgery

Association of l‐tryptophan and an illness resembling eosinophilic fasciitis: clinical and histopathologic findings in four patients with eosinophilia‐myalgia syndrome

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