Eosinophilia-myalgia syndrome
Introduction
Introduction to eosinophilia-myalgia syndrome Scleroderma-like disorders (scleroderma-likedisorders) include eosinophilic fasciitis and eosinophilia-myalgia syndrome (EMS), patients with scleroderma-like skin changes accompanied by myalgia And eosinophilia, the causative factor is suspected to be L-tryptophan, can be relieved by treatment, except for a small number of eosinophilia-muscle pain syndrome patients with peripheral neuropathy, the general prognosis is better. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: myocarditis, pulmonary hypertension, respiratory failure
Cause
Eosinophilia - the cause of myalgia syndrome
Studies have found that L-tryptophan contains trace amounts of tryptophan dimers, whether this chemical is a causative agent of eosinophilic-myalgia syndrome or another unrecognized substance at work. It is still unclear that L-tryptophan products were cancelled in 1990.
Prevention
Eosinophilia - prevention of myalgia syndrome
L-tryptophan drugs should be used with caution when using health supplements.
Complication
Eosinophilia - complications of myalgia syndrome Complications Myocarditis Pulmonary hypertension Respiratory failure
Patients may have myocarditis and arrhythmia, a small number of patients may have pulmonary hypertension, and patients with persistent peripheral nerve atrophy, ascending multiple nerve atrophy can lead to paralysis and respiratory failure.
Symptom
Eosinophilia - symptoms of myalgia syndrome Common symptoms Dyspnea, respiratory failure, joint pain, muscle spasm, pain, rash, muscle pain, fatigue, eosinophilia, paralysis, low fever
The incidence of eosinophilia-myalgia syndrome can be sudden, or insidious, more common in women, early manifestations of hypothermia, fatigue, difficulty breathing, cough, joint pain, arthritis, red rash on the skin But disappeared quickly, the patient may have obvious muscle pain and muscle spasm, invasive lesions may appear in the lungs, scleroderma-like skin changes after 2 to 3 months, but no Raynaud's phenomenon, patients may have myocarditis and heart rhythm Qi, a small number of patients may have pulmonary hypertension, about one-third of patients have eosinophilic fasciitis performance characteristics, some patients with persistent peripheral nerve atrophy, ascending multiple nerve atrophy can lead to paralysis and respiratory failure, patients can have knowledge The ability to recognize declines, manifested as memory loss, can not concentrate attention.
After L-tryptophan was stopped, the clinical symptoms of eosinophilia-myalgia syndrome could not disappear immediately. A chronic process was followed. The patient was followed for 2 years and found that most of the symptoms and signs were excluded except for the recognition ability. Can be improved or disappeared, but one third of patients have worsened their condition and no improvement in peripheral neuropathy.
Examine
Eosinophilia - examination of myalgia syndrome
Patients with early eosinophilia, normal serum phospho-phosphatase (CK) levels, patients with eosinophils increased significantly, eosinophilia - myalgia syndrome has similar histopathological changes with eosinophilic fasciitis .
Patients with myocarditis and arrhythmia, a few patients with pulmonary hypertension, ECG, X-ray can have significant changes.
Diagnosis
Diagnosis and identification of eosinophilia-myalgia syndrome
diagnosis
According to the clinical manifestations of skin lesions, the increase in eosinophils in the surrounding blood and characteristic histopathology can diagnose the disease.
Differential diagnosis
Adult scleredema
The disease sometimes needs to be differentiated from adult scleredema. The latter often begins in the neck, and then spreads to the face, trunk, and finally involves the upper and lower limbs; the lesion is diffuse non-recessed swelling, hard; often before the onset History of upper respiratory tract infection; histopathology showed that collagen fibers were swollen and homogenized, and the gap was filled with an acidic mucopolysaccharide matrix.
2. Dermatomyositis
Dermatomyositis involves the shoulders and the proximal extremities of the muscles; the upper eyelids have edematous purplish red spots and the back of the hands, the Gottron sign of the knuckle back; serum muscle enzymes such as CK, ALT and AST and 24h creatinine excretion Significantly elevated and so on.
3. Systemic scleroderma
Systemic scleroderma is not difficult to distinguish from this disease. The latter has no Raynaud's phenomenon. Visceral involvement (especially in the lungs and gastrointestinal tract) is rare, no telangiectasia, no anti-Scl-70 antibody and anti-centromere antibody. In addition, there was no increase in eosinophils in the blood, and histopathological findings were different.
