Cutaneous Mucinosis in a Patient With Eosinophilia-Myalgia Syndrome Associated With L-Tryptophan Ingestion

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Abstract
To the Editor.— Eosinophilia-myalgia syndrome (EMS) is a recently described illness characterized by eosinophilia of greater than 1000 cells per cubic millimiter (1 × 109/L), generalized myalgia, and the absence of clinical evidence for any other known cause of eosinophilia such as parasitic or fungal infection, end-stage renal disease, leukemia, allergic disorder, and drug reaction.1 Of the 64 reported cases of this syndrome, 98% have included a history of L-tryptophan ingestion prior to the onset of symptoms.2 L-Tryptophan supplements have been prescribed for disorders, including insomnia, depression, and premenstrual syndrome. We have seen a patient with EMS who has developed a bilateral inner arm skin rash whose histologic findings were typical of a cutaneous mucinosis. Report of a Case.— A 37-year-old white woman presented to her local physician in October 1989, with a history of a stiff neck that had progressed to a generalizaed myalgia and

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