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Persistent microvasculopathy in chronic eosinophilia-myalgia syndrome

  [ 9 votes ]   [ Discuss This Article ] • April 15, 1996

Acute eosinophilia-myalgia syndrome (EMS) due to contaminated
L-tryptophan (LT) exposure is an inflammatory microangiopathy
of the dermis, fascia, and muscle. Select individuals evolve
from acute EMS to have persistence of myalgia, fatigue,
cramps, and skin changes for years. Many develop memory
dysfunction and confusion. The objective of this study is to
delineate the pathology in individuals with chronic EMS.
Seventeen patients with ongoing symptoms representing chronic
EMS are studied by skin, fascia, and muscle biopsies four to
five years after exposure to contaminated LT and initial onset
of EMS. All have microvascular disease. Most have lymphocytic
inflammatory infiltrates. Several have dermal sclerosis. The
findings indicate that persistent microvascular disease is
present in chronic EMS. The pathologic changes are similar to
those of acute EMS but with notable differences. Tissue
eosinophil infiltration is rare in the chronic state as
compared to acute EMS. The persistence of endothelial
pathology indicates continuing microvascular dysfunction.

Smith SA

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