Smith B E, Dyck P J
Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN 55905.
Neurology. 1990 Jul;40(7):1035-40. doi: 10.1212/wnl.40.7.1035.
Eosinophilia, brawny induration, and tenderness of the skin and deeper tissues, and eosinophilic and lymphocytic infiltration of skin, deep fascia, and muscle characterize the acute eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan. Many patients have a florid inflammatory myopathy. We evaluated 10 patients with this syndrome in whom peripheral neuropathy was a prominent or the only presenting feature. Two of these patients with severe neuromuscular disease required mechanical ventilation, and 1 died. Clinical severity appeared to be positively associated with the total dose of L-tryptophan ingested. Although the inflammation is generally thought to be more severe in skin, fascia, and muscle, inflammation, especially in the epineurium of sural nerve, was sometimes striking and often accompanied by vasculopathy and angioneogenesis. These cases draw attention to a new preventable syndrome with peripheral nerve involvement, emphasize the value of tissue biopsy for its diagnosis, and raise issues related to pathogenesis.
嗜酸性粒细胞增多、皮肤及深部组织的坚实硬结和压痛，以及皮肤、深筋膜和肌肉的嗜酸性粒细胞和淋巴细胞浸润是与摄入L-色氨酸相关的急性嗜酸性粒细胞增多性肌痛综合征的特征。许多患者患有明显的炎性肌病。我们评估了10例以周围神经病变为突出表现或唯一表现特征的该综合征患者。其中2例患有严重神经肌肉疾病的患者需要机械通气，1例死亡。临床严重程度似乎与摄入的L-色氨酸总量呈正相关。尽管一般认为皮肤、筋膜和肌肉中的炎症更为严重，但炎症，尤其是在腓肠神经的神经外膜中，有时也很明显，且常伴有血管病变和血管生成。这些病例引起了人们对一种新的可预防的伴有周围神经受累的综合征的关注，强调了组织活检对其诊断的价值，并提出了与发病机制相关的问题。
