Eosinophilia-myalgia syndrome and fasciitis with an active alveolitis

This patient clearly had the EMS with eosinophilic fasciitis, apparently due to L-tryptophan. He also had an active alveolitis with a DIP-UIP-like picture. The lung findings were not similar to those reported in the Mayo series. It is perhaps most likely that his interstitial lung disease was of the cryptogenic variety and unrelated to the L-tryptophan. However, a more direct association cannot be ruled out until more cases with similar findings are thoroughly evaluated. We suggest that special consideration of pertinent studies for interstitial lung disease is merited in all patients with suspected EMS. These might include diffusing capacity, gallium scans of lungs, broncho-alveolar lavage and possibly lung biopsy.