Dermatologic Manifestations of Eosinophilia-Myalgia Syndrome Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: May 22, 2012
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, David Arbesfeld, MD, Vinay Arya, MD, and Nicole Quartarolo, MD, to the development and writing of this article.

References

  1. Martínez-Cabot A, Messeguer A. Generation of quinoneimine intermediates in the bioactivation of 3-(N-phenylamino)alanine (PAA) by human liver microsomes: a potential link between eosinophilia-myalgia syndrome and toxic oil syndrome. Chem Res Toxicol. Oct 2007;20(10):1556-62. [Medline].

  2. Allen JA, Peterson A, Sufit R, Hinchcliff ME, Mahoney JM, Wood TA, et al. Post-epidemic eosinophilia-myalgia syndrome associated with L-tryptophan. Arthritis Rheum. Nov 2011;63(11):3633-9. [Medline].

  3. Smith MJ, Garrett RH. A heretofore undisclosed crux of eosinophilia-myalgia syndrome: compromised histamine degradation. Inflamm Res. Nov 2005;54(11):435-50. [Medline].

  4. Smith MJ, Garrett RH. Part II. Eosinophilia-Myalgia Syndrome: further correlations between compromised histamine degradation, eosinophilias and myopathies. Inflamm Res. Mar 14 2007;[Medline].

  5. Rieber N, Belohradsky BH. AHR activation by tryptophan--pathogenic hallmark of Th17-mediated inflammation in eosinophilic fasciitis, eosinophilia-myalgia-syndrome and toxic oil syndrome?. Immunol Lett. Feb 16 2010;128(2):154-5. [Medline].

  6. Akanay-Diesel S, Richter J, Schneider M, Schulte KW, Reifenberger J, Hanneken S. [Shulman's syndrome (eosinophilic fasciitis)]. Hautarzt. Apr 2009;60(4):278-81. [Medline].

  7. Naoui A, Bouslama K, Abdallah M, et al. [Eosinophilic fasciitis (Shulman's disease): a case series of 11 patients]. Rev Med Interne. Aug 2010;31(8):535-9. [Medline].

  8. Firoz BF, Goldberg LH, Landau J, Kaye V, Berman L. Eosinophilic fasciitis secondary to intravenous iron infusions. Dermatol Online J. May 15 2010;16(5):5. [Medline].

  9. Armstrong C, Lewis T, D'Esposito M, Freundlich B. Eosinophilia-myalgia syndrome: selective cognitive impairment, longitudinal effects, and neuroimaging findings. J Neurol Neurosurg Psychiatry. Nov 1997;63(5):633-41. [Medline].

  10. Arnouts PJ, Colemont LJ, Van Outryve MJ, Van Moer EM. L-tryptophan-induced eosinophilia-myalgia syndrome. J Intern Med. Jul 1991;230(1):83-6. [Medline].

  11. Back EE, Henning KJ, Kallenbach LR, Brix KA, Gunn RA, Melius JM. Risk factors for developing eosinophilia myalgia syndrome among L-tryptophan users in New York. J Rheumatol. Apr 1993;20(4):666-72. [Medline].

  12. Blackburn WD Jr. Eosinophilia myalgia syndrome. Semin Arthritis Rheum. Jun 1997;26(6):788-93. [Medline].

  13. Campagna AC, Blanc PD, Criswell LA, Clarke D, Sack KE, Gold WM, et al. Pulmonary manifestations of the eosinophilia-myalgia syndrome associated with tryptophan ingestion. Chest. May 1992;101(5):1274-81. [Medline].

  14. Campbell DS, Morris PD, Silver RM. Eosinophilia-myalgia syndrome: a long-term follow-up study. South Med J. Sep 1995;88(9):953-8. [Medline].

  15. Clauw DJ. Clinical features of eosinophilia myalgia syndrome and related disorders. Adv Exp Med Biol. 1996;398:331-8. [Medline].

  16. Clauw DJ, Pincus T. The eosinophilia-myalgia syndrome: what we know, what we think we know, and what we need to know. J Rheumatol Suppl. Oct 1996;46:2-6. [Medline].

  17. Culpepper RC, Williams RG, Mease PJ, Koepsell TD, Kobayashi JM. Natural history of the eosinophilia-myalgia syndrome. Ann Intern Med. Sep 15 1991;115(6):437-42. [Medline].

  18. De Schryver-Kecskemeti K, Bennert KW, Cooper GS, Yang P. Gastrointestinal involvement in L-tryptophan (L-Trp) associated eosinophilia-myalgia syndrome (EMS). Dig Dis Sci. May 1992;37(5):697-701. [Medline].

  19. Diggle GE. The toxic oil syndrome: 20 years on. Int J Clin Pract. Jul-Aug 2001;55(6):371-5. [Medline].

  20. Draznin E, Rosenberg NL. Intensive rehabilitative approach to eosinophilia myalgia syndrome associated with severe polyneuropathy. Arch Phys Med Rehabil. Jul 1993;74(7):774-6. [Medline].

  21. Eosinophilia-Myalgia Syndrome: Review and Reappraisal of Clinical, Epidemiologic and Animal Studies Symposium. Washington, D.C., USA, December 7-8, 1994. Proceedings. J Rheumatol Suppl. Oct 1996;46:1-110. [Medline].

  22. Espinoza LR. The eosinophilia myalgia syndrome: to be or not to be. Semin Arthritis Rheum. Jun 1997;26(6):781-4. [Medline].

  23. Falk H, Briss P. Environmental- and injury-related epidemic-assistance investigations, 1946-2005. Am J Epidemiol. Dec 1 2011;174(11 Suppl):S65-79. [Medline].

  24. Freimer ML, Glass JD, Chaudhry V, Tyor WR, Cornblath DR, Griffin JW, et al. Chronic demyelinating polyneuropathy associated with eosinophilia- myalgia syndrome. J Neurol Neurosurg Psychiatry. May 1992;55(5):352-8. [Medline].

  25. Greenberg AS, Takagi H, Hill RH, Hasan A, Murata H, Falanga V. Delayed onset of skin fibrosis after the ingestion of eosinophilia- myalgia syndrome-associated L-tryptophan. J Am Acad Dermatol. Aug 1996;35(2 Pt 1):264-6. [Medline].

  26. Gross B, Ronen N, Honigman S, Livne E. Tryptophan toxicity--time and dose response in rats. Adv Exp Med Biol. 1999;467:507-16. [Medline].

  27. Hatch DL, Goldman LR. Reduced severity of eosinophilia-myalgia syndrome associated with the consumption of vitamin-containing supplements before illness. Arch Intern Med. Oct 25 1993;153(20):2368-73. [Medline].

  28. Hedberg K, Urbach D, Slutsker L, Matson P, Fleming D. Eosinophilia-myalgia syndrome. Natural history in a population-based cohort. Arch Intern Med. Sep 1992;152(9):1889-92. [Medline].

  29. Henning KJ, Jean-Baptiste E, Singh T, Hill RH, Friedman SM. Eosinophilia-myalgia syndrome in patients ingesting a single source of L-tryptophan. J Rheumatol. Feb 1993;20(2):273-8. [Medline].

  30. Hepburn A, Coady A, Livingstone J, Pandit N. Eosinophilic cholecystitis as a possible late manifestation of the eosinophilia-myalgia syndrome. Clin Rheumatol. 2000;19(6):470-2. [Medline].

  31. Hertzman PA. Criteria for the definition of the eosinophilia-myalgia syndrome. J Rheumatol Suppl. Oct 1996;46:7-12. [Medline].

  32. Hertzman PA, Borda IA. The toxic oil syndrome and the eosinophilia-myalgia syndrome: pursuing clinical parallels. J Rheumatol. Oct 1993;20(10):1707-10. [Medline].

  33. Hertzman PA, Clauw DJ, Duffy J, Medsger TA Jr, Feinstein AR. Rigorous new approach to constructing a gold standard for validating new diagnostic criteria, as exemplified by the eosinophilia-myalgia syndrome. Arch Intern Med. Oct 22 2001;161(19):2301-6. [Medline].

  34. Hertzman PA, Clauw DJ, Kaufman LD, Varga J, Silver RM, Thacker HL, et al. The eosinophilia-myalgia syndrome: status of 205 patients and results of treatment 2 years after onset. Ann Intern Med. Jun 1 1995;122(11):851-5. [Medline].

  35. Hertzman PA, Kaufman LD, Love LA, Mease PJ, Philen RM, Pincus T, et al. The eosinophilia-myalgia syndrome--guidelines for patient care. J Rheumatol. Jan 1995;22(1):161-3. [Medline].

  36. Hess EV. Eosinophilia-myalgia syndrome: opportunities realized and missed. J Rheumatol. Jun 1997;24(6):1239-40. [Medline].

  37. Hudson JI, Pope HG Jr, Carter WP, Daniels SR. Fibromyalgia, psychiatric disorders, and assessment of the longterm outcome of eosinophilia-myalgia syndrome. J Rheumatol Suppl. Oct 1996;46:37-42; discussion 42-3. [Medline].

  38. Johnson KL, Klarskov K, Benson LM, Williamson BL, Gleich GJ, Naylor S. Presence of peak X and related compounds: the reported contaminant in case related 5-hydroxy-L-tryptophan associated with eosinophilia-myalgia syndrome. J Rheumatol. Dec 1999;26(12):2714-7. [Medline].

  39. Kamb ML, Murphy JJ, Jones JL, Caston JC, Nederlof K, Horney LF, et al. Eosinophilia-myalgia syndrome in L-tryptophan-exposed patients. JAMA. Jan 1 1992;267(1):77-82. [Medline].

  40. Kaufman LD. Eosinophilia-myalgia syndrome: morbidity and mortality. J Rheumatol. Oct 1993;20(10):1644-6. [Medline].

  41. Kaufman LD, Kaufman MA, Krupp LB. Movement disorders in the eosinophilia-myalgia syndrome: tremor, myoclonus, and myokymia. J Rheumatol. Jan 1995;22(1):157-60. [Medline].

  42. Kaufman LD, Seidman RJ, Phillips ME, Gruber BL. Cutaneous manifestations of the L-tryptophan-associated eosinophilia-myalgia syndrome: a spectrum of sclerodermatous skin disease. J Am Acad Dermatol. Dec 1990;23(6 Pt 1):1063-9. [Medline].

  43. Kilbourne EM, Philen RM, Kamb ML, Falk H. Tryptophan produced by Showa Denko and epidemic eosinophilia-myalgia syndrome. J Rheumatol Suppl. Oct 1996;46:81-8; discussion 89-91. [Medline].

  44. Klarskov K, Johnson KL, Benson LM, Gleich GJ, Naylor S. Eosinophilia-myalgia syndrome case-associated contaminants in commercially available 5-hydroxytryptophan. Adv Exp Med Biol. 1999;467:461-8. [Medline].

  45. Martínez-Osuna P, Espinoza LR. On the treatment of the eosinophilia-myalgia syndrome. Arch Intern Med. Jun 1991;151(6):1239. [Medline].

  46. Medsger TA Jr. Tryptophan-induced eosinophilia-myalgia syndrome. N Engl J Med. Mar 29 1990;322(13):926-8. [Medline].

  47. Muller B, Pacholski C, Simat T, Steinhart H. Synthesis and formation of an EMS correlated contaminant in biotechnologically manufactured L-tryptophan. Adv Exp Med Biol. 1999;467:481-6. [Medline].

  48. Namey JJ Jr, DiGiovanni RL, Sobonya RE. Eosinophilia-Myalgia syndrome associated with tryptophan. South Med J. Jun 1990;83(6):675-8. [Medline].

  49. Naylor S, Johnson KL, Williamson BL, Klarskov K, Gleich GJ. Structural characterization of contaminants in commercial preparations of melatonin by on-line HPLC-electrospray ionization-tandem mass spectrometry. Adv Exp Med Biol. 1999;467:769-77. [Medline].

  50. Naylor S, Williamson BL, Johnson KL, Gleich GJ. Structural characterization of case-associated contaminants peak C and FF in L-tryptophan implicated in eosinophilia-myalgia syndrome. Adv Exp Med Biol. 1999;467:453-60. [Medline].

  51. Ostezan LB, Callen JP. Cutaneous manifestations of selected rheumatologic diseases. Am Fam Physician. Apr 1996;53(5):1625-36. [Medline].

  52. Philen RM, Posada M. Toxic oil syndrome and eosinophilia-myalgia syndrome: May 8-10, 1991, World Health Organization meeting report. Semin Arthritis Rheum. Oct 1993;23(2):104-24. [Medline].

  53. Pickering MC, Walport MJ. Eosinophilic myopathic syndromes. Curr Opin Rheumatol. Nov 1998;10(6):504-10. [Medline].

  54. Pincus T. Eosinophilia-myalgia syndrome: patient status 2-4 years after onset. J Rheumatol Suppl. Oct 1996;46:19-24; discussion 24-5. [Medline].

  55. Ronen N, Livne E, Gross B. Oxidative damage in rat tissue following excessive L-tryptophan and atherogenic diets. Adv Exp Med Biol. 1999;467:497-505. [Medline].

  56. Sack KE, Criswell LA. Eosinophilia-myalgia syndrome: the aftermath. South Med J. Sep 1992;85(9):878-82. [Medline].

  57. Silver RM. Pathophysiology of the eosinophilia-myalgia syndrome. J Rheumatol Suppl. Oct 1996;46:26-36. [Medline].

  58. Silver RM, McKinley K, Smith EA, Quearry B, Harati Y, Sternberg EM, et al. Tryptophan metabolism via the kynurenine pathway in patients with the eosinophilia-myalgia syndrome. Arthritis Rheum. Sep 1992;35(9):1097-105. [Medline].

  59. Smith SA. Persistent microvasculopathy in chronic eosinophilia-myalgia syndrome. Adv Exp Med Biol. 1996;398:359-64. [Medline].

  60. Stahl JL, Cook EB, Pariza MA, Cook ME, Graziano FM. Effect of L-tryptophan supplementation on eosinophils and eotaxin in guinea pigs. Exp Biol Med (Maywood). Mar 2001;226(3):177-84. [Medline].

  61. Sternberg EM. Pathogenesis of L-tryptophan eosinophilia myalgia syndrome. Adv Exp Med Biol. 1996;398:325-30. [Medline].

  62. Sullivan EA, Kamb ML, Jones JL, Meyer P, Philen RM, Falk H, et al. The natural history of eosinophilia-myalgia syndrome in a tryptophan-exposed cohort in South Carolina. Arch Intern Med. May 13 1996;156(9):973-9. [Medline].

  63. Sullivan EA, Staehling N, Philen RM. Eosinophilia-myalgia syndrome among the non-L-tryptophan users and pre- epidemic cases. J Rheumatol. Oct 1996;23(10):1784-7. [Medline].

  64. Swygert LA, Back EE, Auerbach SB, Sewell LE, Falk H. Eosinophilia-myalgia syndrome: mortality data from the US national surveillance system. J Rheumatol. Oct 1993;20(10):1711-7. [Medline].

  65. Takagi H, Ochoa MS, Zhou L, Helfman T, Murata H, Falanga V. Enhanced collagen synthesis and transcription by peak E, a contaminant of L-tryptophan preparations associated with the eosinophilia myalgia syndrome epidemic. J Clin Invest. Nov 1995;96(5):2120-5. [Medline].

  66. Tazelaar HD, Myers JL, Drage CW, King TE Jr, Aguayo S, Colby TV. Pulmonary disease associated with L-tryptophan-induced eosinophilic myalgia syndrome. Clinical and pathologic features. Chest. May 1990;97(5):1032-6. [Medline].

  67. Tranchesi B, Chamone DF, Cobbaert C, Van de Werf F, Vanhove P, Verstraete M. Coronary recanalization rate after intravenous bolus of alteplase in acute myocardial infarction. Am J Cardiol. Jul 15 1991;68(2):161-5. [Medline].

  68. Valicenti JM, Fleming MG, Pearson RW, Budz JP, Gendleman MD. Papular mucinosis in L-tryptophan-induced eosinophilia-myalgia syndrome. J Am Acad Dermatol. Jul 1991;25(1 Pt 1):54-8. [Medline].

  69. Vanhooren HM, Vanoirbeek JA, Xu H, Verbeken E, Nemery B. Strain-dependent acute lung injury after intra-tracheal administration of a 'refined' aniline-denatured rapeseed oil: a murine model of the toxic oil syndrome?. Food Chem Toxicol. Dec 2007;45(12):2563-73. [Medline].

  70. Varga J, Kahari VM. Eosinophilia-myalgia syndrome, eosinophilic fasciitis, and related fibrosing disorders. Curr Opin Rheumatol. Nov 1997;9(6):562-70. [Medline].

  71. Varga J, Li L, Jimenez SA. Increased type I collagen gene expression in L-tryptophan associated eosinophilia-myalgia syndrome skin fibroblasts. J Rheumatol. Aug 1993;20(8):1303-8. [Medline].

  72. Varga J, Maul GG, Jimenez SA. Autoantibodies to nuclear lamin C in the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion. Arthritis Rheum. Jan 1992;35(1):106-9. [Medline].

  73. Varga J, Uitto J, Jimenez SA. The cause and pathogenesis of the eosinophilia-myalgia syndrome. Ann Intern Med. Jan 15 1992;116(2):140-7. [Medline].

  74. Williamson BL, Benson LM, Tomlinson AJ, Mayeno AN, Gleich GJ, Naylor S. On-line HPLC-tandem mass spectrometry analysis of contaminants of L-tryptophan associated with the onset of the eosinophilia-myalgia syndrome. Toxicol Lett. Jul 21 1997;92(2):139-48. [Medline].

  75. Williamson BL, Johnson KL, Tomlinson AJ, Gleich GJ, Naylor S. On-line HPLC-tandem mass spectrometry structural characterization of case-associated contaminants of L-tryptophan implicated with the onset of eosinophilia myalgia syndrome. Toxicol Lett. Oct 15 1998;99(2):139-50. [Medline].

 
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