Eosinophilia - Myalgia Syndrome

65 year old Nigerian Indian presented with fever, bone and joint pains as well as severe pain in hands and calf muscles since 3 months. Itchy, extensive skin rash appeared along with. The rash did respond to therapy with residual pigmentation on his forehead. Fever did not respond despite various antibiotics including those used for tuberculosis. He then came to India for further management. His examination revealed pigmentation over forehead, muscle tenderness over extremities, swollen and tender wrist joints and pain and crepitus in both knees (suggestive of osteoarthritis). Blood examination revealed high eosinophil (a type of white blood cell) count and raised ESR. Other laboratory investigations were normal. Fever and myalgia responded to steroids and painkillers. The patient went back to Nigeria after 3 weeks or so.

Eosinophilia Myalgia syndrome is closely linked to ingestion of tryptophan in diet although evidence of its ingestion is not essential for diagnosis of this disease. Tryptophan was, therefore, withdrawn from US market in 1991 but sales were again allowed from 2001. Tryptophan is available in food stores as diet supplement. People use it for insomnia, depression and menstrual problems. Average daily dose of 1250 mg for 6 months to 9 years is supposed to lead to this disease.
Tryptophan is a routine constituent of most protein-based foods or dietary proteins. Chocolates, oats, bananas, mangoes, dried dates, milk and milk products, spirulina, peanuts, red meat, eggs, fish, poultry and turkey are all rich sources of tryptophan.

Symptoms of Eosinophilia Myalgia syndrome can be difficult to respond to therapy. Muscle pain and weakness, fatigue, joint pains, breathlessness, memory loss and numbness can persist even at the end of 1-4 years.