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本文报告1例L-色氨酸引起嗜酸性细胞增多性肌痛综合征的典型病例。患者,男,63岁。因失眠而长期睡前服用L-色氨酸3g.治疗7个月后患者出现肺炎(体温39.4C)及散在的红斑疹,感觉中度瘙痒和广泛性肌痛。体检见所有肌群中度触痛,双臂和双腿呈轻度“肌性”水肿,有弥散性红斑,双手掌脱屑。患者手臂与腿近端肌肉轻度萎缩且张力减低。实验室检查发现患者的嗜酸性粒细胞高达3300/μl.肌活检示血管周和肌束膜浆细胞及淋巴细胞浸润,并有散在的嗜酸性细胞。即诊断为“嗜酸性细胞增多性肌炎/筋膜炎”。经停用L-色氨酸后,患者的嗜酸性细胞降至1300/μl.
This article reports a case of L-tryptophan-induced eosinophilic myalgia syndrome typical cases. Patient, male, 63 years old. L-Tryptophan 3g was taken long-term at bedtime due to insomnia, pneumonia (39.4C) and scattered erythema were observed in 7 months after treatment, with moderate itching and extensive myalgia. Physical examination showed moderate tenderness in all muscle groups, with mild “muscular” edema in both arms and legs, disseminated erythema, and both hands scaling. The patient’s arm and leg proximal muscle mild atrophy and tension decreased. Laboratory tests found that patients with eosinophils as high as 3300 / l.Microspheresis showed perivascular and myometrial plasma cells and lymphocyte infiltration, and scattered eosinophils. That is diagnosed as “eosinophilic myositis / fasciitis.” After deactivation of L-tryptophan, the patient’s eosinophils decreased to 1300 / μl.