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[Eosinophilia-myalgia syndrome].

S Reinauer1, G Plewig

  • 1Hautklinik, Heinrich-Heine-Universität Düsseldorf.

Der Hautarzt; Zeitschrift Fur Dermatologie, Venerologie, Und Verwandte Gebiete
|March 1, 1991
PubMed
Summary

Eosinophilia-myalgia syndrome (EMS) outbreaks, linked to contaminated L-tryptophan, cause severe myalgias and skin rashes. HPLC analysis identified a specific chemical contaminant as the likely cause.

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Area of Science:

  • Toxicology
  • Immunology
  • Epidemiology

Background:

  • Eosinophilia-myalgia syndrome (EMS) emerged in 1989, with subsequent cases reported globally.
  • EMS is characterized by severe myalgias, rash, edema, and peripheral eosinophilia (>1,000/mm3).

Observation:

  • Patients present with a distinct set of symptoms including myalgias, various rashes, edema, fever, pneumonia, and fatigue.
  • Peripheral eosinophilia exceeding 1,000 cells/mm³ is a key diagnostic marker.

Findings:

  • A contamination during L-tryptophan production, potentially involving Bacterium amyloliquefaciens, is the suspected etiology.
  • High-Performance Liquid Chromatography (HPLC) analysis identified a specific contaminant: a condensation product of acetaldehyde and tryptophan.

Implications:

  • Understanding the chemical nature of the contaminant is crucial for preventing future outbreaks.
  • Comparative analysis with Shulman syndrome and toxic-oil syndrome aids in differential diagnosis and understanding pathogenesis.

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