Epidemiology
- Epidemic occurred in late 1980’s (1500 cases reported)
Etiology
- Ingestion of contaminated L-tryptophan
Physiology
- Pulmonary vasculitis
Pathologic Patterns
- Vasculitis with fibrointimal hyperplasia: often associated with interstitial infiltrates
Diagnosis
- PFT’s: decreased DLCO/ increased Vd/Vt ratio
- ABG: elevated A-a gradient
- CBC: marked peripheral eosinophilia
- CXR
- Alveolar infiltrates:
- Interstitial infiltrates:
- Pleural effusion:
- OLB: diffuse non-necrotizing vasculitis with fibrointimal hyperplasia, interstitial infiltration
Clinical
Typical Eosinophilia-Mylagia Presentation
(>50% of cases had respiratory complaints)
- Skin Involvement
- Rash
- Pulmonary Involvement (50%):
- Dyspnea
- Pulmonary Infiltrates (see [[Drug-Induced Pulmonary Eosinophilia]])
- Interstitial Lung Disease
- Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]]): due to pulmonary vasculitis
- Neurologic:
- Peripheral Neuropathy
- Myositis
- Consitutional
- Myalgias
- Athralgias
- Fasciitis
- Edema
- Fatigue
Scleroderma-Like Syndrome (see [[Scleroderma]])
- Has been reported with L-tryptophan ingestion
Treatment
- Discontinue L-tryptophan
- Corticosteroids: may be useful
- Some patients improved, but response is often incomplete (with chronic, progressive disease(
Prognosis
- May occasionally be chronic, progressive (even with treatment)
References
- xxx