AXONAL NEUROPATHY IN EOSINOPHILIA-MYALGIA-SYNDROME

Three patients with eosinophilia-myalgia syndrome linked to consumptio n of L-tryptophan supplement developed a severe sensorimotor axonal ne uropathy. All three had myalgia, elevated eosinophil count, and later developed fasciitis. Neuropathy was found at all stages of the illness and resulted in disability which was irreversible despite cessation o f L-tryptophan. Nerve conduction studies showed reduced motor and sens ory evoked response amplitudes with select sparing of some nerves and the arms were more involved than the legs. Cerebrospinal fluid protein content was increased in one of two patients so tested. Creatine kina se was normal and muscle biopsy showed perimysial inflammation. Sural nerve biopsy in one case showed epineural perivascular inflammation. O ur data showed that a severe sensorimotor axonal neuropathy occurs in eosinophilia-myalgia syndrome, suggestive of mononeuritis multiplex. ( C) 1994 John Wiley and Sons, Inc.