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Microangiopathy in the eosinophilia-myalgia syndrome
S A Smith1, R I Roelofs, E Gertner
1Department of Neurology, University of Minnesota Medical School, Minneapolis.
The Journal of Rheumatology
|November 1, 1990
Summary
Eosinophilia-myalgia syndrome (EMS), linked to L-tryptophan, involves inflammation and microvascular damage in skin, fascia, and muscle. Pathologic findings suggest potential ischemia contributes to this condition.
Area of Science:
- Pathology
- Toxicology
- Rheumatology
Background:
- Eosinophilia-myalgia syndrome (EMS) emerged in 1989, linked to L-tryptophan supplements.
- The condition presents with myalgia, eosinophilia, and various skin and systemic manifestations.
Purpose of the Study:
- To perform a detailed pathologic examination of biopsies from patients with EMS.
- To elucidate the microvascular and tissue-specific changes associated with L-tryptophan-induced EMS.
Main Methods:
- Analysis of skin, fascial, and skeletal muscle biopsies from 21 EMS patients.
- Utilized light microscopy, histochemistry, and electron microscopy for detailed tissue evaluation.
Main Results:
- Consistently observed perivascular lymphocytic infiltrates with eosinophils in dermal, fascial, and muscle tissues.
- Identified lymphocytic infiltration within arteries and arterioles.
- Electron microscopy revealed endothelial cell thickening and necrosis in capillaries and arterioles, indicating microangiopathy.
Conclusions:
- The observed microangiopathy in EMS patients suggests that tissue ischemia may play a significant role in the syndrome's pathology.
- Pathologic findings highlight the systemic inflammatory and vascular effects of L-tryptophan exposure.