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What are the causes and treatment of eosinophils myalgia syndrome (EMS)?

Q: I have been suffering from severe body pain for almost a year. Recently a blood test was done, as per that two values are out of range. The AE Count is 1200 Cells/cmm and Eosinophils 11%. The thyroid test values are in normal range and the RA and CRP test result is negative. The doctor has suggested prednisone (OMNACARTIL) and Coral calcium. I have allergy problems and am taking Neoloridin 1 tab per day and also using Meta spray twice daily for more than a year. I also use Seroflo 250 mg inhaler twice daily. I also suffer from hay fever. The high eosinophils figure may be due to that also. What is the affect of high eosinophils in the short range and long range? Can it result in high body pain?

A:One must exclude the possibility of hypereosinophilic syndrome, eosinophilic fasciitis, dermatomyositis, mixed connective tissue disease etc. There is also a disorder called Eosinophilia-myalgia syndrome (EMS) that was first recognized in 1989 in New Mexico. The 3 patients had an illness with unique symptoms, including peripheral blood eosinophilia and severe myalgias (muscle pain). All 3 patients had ingested sleeping aids containing L-tryptophan. In the following weeks, a nationwide epidemic of EMS became apparent and was correlated with the use of over-the-counter compounds containing L-tryptophan. In response, the US Food and Drug Administration ordered a recall of all single-entity products containing L-tryptophan. In 1989, the Centers for Disease Control and Prevention (CDC) issued the following case definition for EMS: (1) a peripheral eosinophil count of at least 1.0 X 109 cells/L, (2) a generalized myalgia at some point during the illness that is severe enough to affect the patients ability to perform his or her usual daily activities, and (3) no evidence of infection or neoplasm that could explain either the eosinophilia or the myalgia. EMS is an illness characterized by pruritus, cutaneous lesions, edema, sclerodermoid changes, and joint pain, in addition to dramatic myalgia and eosinophilia. In the early phase of the disease, most patients have muscle aches; cough; dyspnea; macules, papules, or urticarial skin lesions; intense pruritus; constitutional symptoms, such as fatigue, fever, and weight loss; and persistent, incapacitating myalgias. This phase lasts weeks to months and is followed by a chronic phase characterized by sclerodermoid skin changes, neuropathy, neurocognitive deficits, continued myalgia, and muscle cramps. Other less common chronic manifestations involve the pulmonary, cardiac, and gastrointestinal systems. The case definition of EMS is useful to identify patients with suspected EMS; however, to ensure a more accurate diagnosis, a more stringent set of criteria must be applied. One set of proposed classification criteria includes 4 axes: (1) the presence of a distinct acute episode with the typical signs and symptoms; (2) major physical findings, including typical involvement of organs, such as the skin, the muscles, the lungs, and the nerves; (3) characteristic laboratory values, including an eosinophil count greater than 1.0 X 109 cells/L; and (4) characteristic histopathologic features. The most important component of treatment is to discontinue the use of any product containing L-tryptophan. The mainstay of pharmacologic treatment is glucocorticoid therapy, which benefits many patients but is not effective for all symptoms of EMS. Usually, eosinophilia markedly decreases, and oedema and pulmonary infiltrates resolve in response to glucocorticoids. Nonsteroidal anti-inflammatory agents and narcotic analgesics may be useful for the relief of severe muscle pain. Other care depends on the manifestations of the disease. In many cases, it is mostly supportive. Please consult a physician or a rheumatologist to discuss this.


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