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A Case of the Eosinophilia-Myalgia Syndrome Associated with Use of an L-Tryptophan Product

Michael T. Flannery, MD; Paul M. Wallach, MD; Luis R. Espinoza, MD; Michael P. Dohrenwend, MD; and Lynn C. Moscinski, MD
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Requests for Reprints: Paul M. Wallach, MD, University of South Florida College of Medicine, Department of Internal Medicine, Box 19, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612.

Current Author Addresses: Drs. Flannery, Wallach, Espinoza, and Dohrenwend: University of South Florida College of Medicine, Department of Internal Medicine, Box 19, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612.

Dr. Moscinski: H. Lee Moffitt Cancer and Research Institute, Department of Pathology, University of South Florida, Tampa, FL 33612.

Ann Intern Med. 1990;112(4):300-301. doi:10.7326/0003-4819-112-4-300
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L-Tryptophan has been used as a sedative hypnotic for insomnia and as an antidepressant for many years. Previously reported toxicity has included nausea, vomiting, ataxia, hyperreflexia, possibly metabolite-induced bladder carcinogenesis, and worsening of hepatic encephalopathy in patients with a portocaval shunt (1, 2). Recent reports from the Centers for Disease Control (3, 4) indicate that there may be an association between the use of L-tryptophan products and development of a syndrome of myalgias and eosinophilia. We report a case of the eosinophilia-myalgia syndrome without other known causes of eosinophilia and associated with use of an L-tryptophan product. When L-tryptophan was


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