A 65-year-old Nigerian Indian presented with fever, bone and joint pains, and severe pain in hands and calf muscles for three months. An itchy, extensive skin rash was also present. 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 the forehead, muscle tenderness over extremities, swollen and tender wrist joints, and pain and crepitus in both knees (suggestive of osteoarthritis). Blood examination revealed a 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 three weeks or so.
Eosinophilia Myalgia syndrome is closely linked to ingestion of tryptophan in the diet. However, evidence of its ingestion is not essential for the diagnosis of this disease. Tryptophan was, therefore, withdrawn from the US market in 1991, but sales were again allowed from 2001. Tryptophan is available in food stores as a diet supplement. People use it for insomnia, depression, and menstrual problems. An average daily dose of 1250 mg for six months to 9 years is supposed to lead to this disease.
Tryptophan is usually a 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 challenging 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.