Peripheral neuropathy associated with eosinophilia-myalgia syndrome

T. D HEIMAN-PATTERSON; S. J BIRD; A. J TAHMOUSH; G. J PARRY; J VARGA; M. E SHY; N. W CULLIGAN; L EDESOHN; G. T TATARIAN; M. P HEYES; C. A GARCIA

doi:10.1002/ana.410280409

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Peripheral neuropathy associated with eosinophilia-myalgia syndrome

Journal article

Peer reviewed

Peripheral neuropathy associated with eosinophilia-myalgia syndrome

T. D HEIMAN-PATTERSON, S. J BIRD, A. J TAHMOUSH, G. J PARRY, J VARGA, M. E SHY, N. W CULLIGAN, L EDESOHN, G. T TATARIAN, M. P HEYES, …

Annals of neurology, Vol.28(4), pp.522-528

1990

DOI: 10.1002/ana.410280409

PMID: 2174666

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Abstract

In 1989, the Centers for Disease Control recognized the existence of an epidemic illness characterized by myalgia and eosinophilia in individuals taking preparations containing L-tryptophan. We evaluated 3 patients with eosinophilia-myalgia syndrome who presented with subacute progressive neuropathies. The neuropathies were predominantly motor and maximal in the lower extremities. Two patients were confined to a wheelchair and one was ventilator-dependent and bedridden. Sensory loss predominantly involved small fiber modalities. Electrophysiological studies showed multifocal marked conduction slowing and conduction block indicating segmental demyelination, with associated axonal degeneration that was accentuated distally. Examination of sural nerve biopsy specimens demonstrated axonal degeneration in all 3 patients and perivascular infiltrates in 2. Levels of quinolinic acid, a neurotoxic metabolite of L-tryptophan, were elevated in the cerebrospinal fluid in the 2 patients in whom it was measured. The cause of the neuropathy is unknown but may include immune mechanisms or toxicity of eosinophils, L-tryptophan, its metabolic products, or contaminants within L-tryptophan preparations.

Neurology

Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction

Biological and medical sciences

Medical sciences

Nervous system (semeiology, syndromes)

Details

Title: Subtitle: Peripheral neuropathy associated with eosinophilia-myalgia syndrome
Creators: T. D HEIMAN-PATTERSON - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
S. J BIRD - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
A. J TAHMOUSH - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
G. J PARRY - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
J VARGA - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
M. E SHY - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
N. W CULLIGAN - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
L EDESOHN - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
G. T TATARIAN - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
M. P HEYES - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
C. A GARCIA - Univ. Pennsylvania, dep. neurology, Pennsylvania PA 19107-5083, United States
Resource Type: Journal article
Publication Details: Annals of neurology, Vol.28(4), pp.522-528
Publisher: Willey-Liss; Hoboken
DOI: 10.1002/ana.410280409
PMID: 2174666
ISSN: 0364-5134
eISSN: 1531-8249
Language: English
Date published: 1990
Academic Unit: Neurology; Molecular Physiology and Biophysics; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
Record Identifier: 9984020655202771

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