Hypersensitivity Pneumonitis and Pulmonary Vasculitis with Eosinophilia in a Patient Taking an <scp>L</scp>-Tryptophan Preparation

Abstract

Brief Reports15 February 1990Hypersensitivity Pneumonitis and Pulmonary Vasculitis with Eosinophilia in a Patient Taking an L-Tryptophan PreparationWilliam D. Travis, MD, Michael E. Kalafer, MD, Howard S. Robin, MD, F. J. Luibel, MDWilliam D. Travis, MDSearch for more papers by this author, Michael E. Kalafer, MDSearch for more papers by this author, Howard S. Robin, MDSearch for more papers by this author, F. J. Luibel, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-4-301 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDietary intake of L-tryptophan tablets has recently been found to be associated with a potentially fatal disorder called the eosinophilia-myalgia syndrome (1, 2). This disorder is primarily characterized by peripheral blood eosinophilia and severe myalgias. We report a case of hypersensitivity pneumonitis and pulmonary vasculitis associated with eosinophilia in a patient taking an L-tryptophan preparation.Case ReportA 70-year-old woman presented with a 1- to 2-week history of fatigue and weakness, cough with brown sputum, and several days of progressive dyspnea associated with bifrontal headache. An outpatient chest radiograph, 2 days before admission, showed bilateral perihilar and lower-lobe alveolar infiltrates,...References1. Eosinophilia-myalgia syndrome—New Mexico. MMWR. 1989;38:765-7. MedlineGoogle Scholar2. Eosinophilia-myalgia syndrome and L-tryptophan-containing products-New Mexico, Minnesota, Oregon, and New York, 1989. MMWR. 1989;38:785-8. MedlineGoogle Scholar3. CooperWhiteMatthay JDR. Drug-induced pulmonary disease. Part 2. Noncytotoxic drugs. Am Rev Respir Dis. 1986;133:488-505. MedlineGoogle Scholar4. FulkersonGockerman WJ. Pulmonary disease induced by drugs. In: Fishman AP, ed. Pulmonary Diseases and Disorders. 2d ed. New York: McGraw-Hill Book Co.; 1988:793-811. Google Scholar5. Whimsterde Poitiers WW. The lung. In: Ridell RH, ed. Pathology of Drug-Induced and Toxic Diseases. New York: Churchill Living-stone; 1982:167-200. Google Scholar6. LeavittFauci RA. Pulmonary vasculitis. Am Rev Respir Dis. 1986;134:149-66. MedlineGoogle Scholar7. KerrLinnabary LR. A review of interstitial pneumonia in cattle. Vet Hum Toxicol. 1989;31:247-54. MedlineGoogle Scholar8. BradleyCarlson BJ. Ultrastructural pulmonary changes induced by intravenously administered 3-methylindole in goats. Am J Pathol. 1980;99:551-60. MedlineGoogle Scholar9. KirklandBray JT. The effect of 3-methylindole on the quantity and functional quality of lung surfactant. Can J Physiol Pharmacol. 1988;66:895-900. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: William D. Travis, MD; Michael E. Kalafer, MD; Howard S. Robin, MD; F. J. Luibel, MDAffiliations: From the National Institutes of Health, Bethesda, Maryland; and Sharp Cabrillo Hospital, San Diego, California. For current author addresses, see end of text. 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