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June 3, 1992, Vol 267, No. 21 >
ARTICLE | June 3, 1992

Repeated Coronary Artery Spasm in a Young Woman With the Eosinophilia-Myalgia Syndrome FREE

Phillip A. Hertzman, MD; Gerry L. Maddoux, MD; Esther M. Sternberg, MD; Melvyn P. Heyes, PhD; Ivan N. Mefford, PhD; Gail M. Kephart; Gerald J. Gleich, MD
[+] Author Affiliations

Reprint requests to Los Alamos Medical Center, Los Alamos, NM 87544 (Dr Hertzman).


JAMA. 1992;267(21):2932-2934. doi:10.1001/jama.1992.03480210094039
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References

We report a case of repeated coronary artery spasm with myocardial injury in a 37-year-old woman with the eosinophilia-myalgia syndrome. This patient did not have a medical history of cardiac-related illness or risk factors for coronary artery disease. The presence of eosinophil granule major basic protein in otherwise normal-appearing myocardial tissue, along with normal plasma levels of tryptophan metabolites, suggests that the mechanism of vasospasm in this patient might involve toxic eosinophil proteins or focal myocardial lesions, but not the production of excess tryptophan metabolites.

(JAMA. 1992;267:2932-2934)

REFERENCES

1 +
Hertzman A, Falk H, Kilbourne EM, Page S, Shulman LE.  The eosinophilia-myalgia syndrome: the Los Alamos Conference. J Rheumatol . 1991;; 18:867-873.
2 +
Swygert LA, Maes EF, Sewell LE, Miller L, Falk E, Kilbourne EM.  Eosinophilia-myalgia syndrome: results of national surveillance. JAMA . 1990;; 264:1698-1703.
3 +
Kaufman LE, Gruber BL, Gregersen PK.  Clinical follow-up and immunogenetic studies of 32 patients with eosinophilia-myalgia syndrome. Lancet . 1991;;337:1071-1074.
4 +
Kalsner S, Richards R.  Coronary arteries of cardiac patients are hyperreactive and contain stores of amines: a mechanism for coronary artery spasm. Science . 1984;;223:1435-1437.
5 +
Giuliani E, Fuster V, Gersh B, McGoon M, McGoon D. Cardiology: Fundamentals and Practice . 2nd ed. St Louis, Mo: Mosby—Year Book; 1991;:1309.
6 +
Hirakawa Y, Koyanagi S, Matsumoto T, Takeshita A, Nakamura M.  A case of variant angina associated with eosinophilia. Am J Med . 1989;;87: 472-474.
7 +
Silver RM, Heyes MP, Maize JC, Quearry B, Vionnet-Fuasset M, Sternberg EM.  Scleroderma, fasciitis, and eosinophilia associated with ingestion of L-tryptophan. N Engl J Med . 1990;;322:874-881.
8 +
Filley WV, Holley KE, Kephart GM, Gleich GJ.  Identification by immunofluorescence of eosinophil granule major basic protein in lung tissues of patients with bronchial asthma. Lancet . 1982;;2:11-16.
9 +
Peters MS, Schroeter AL, Kephart GM, Gleich GJ.  Localization of eosinophil granule major basic protein in chronic urticaria. J Invest Dermatol . 1983;; 81:39-43.
10 +
Maddox DE, Kephart GM, Cuolam CB, Butterfield JH, Benirschke K, Gleich GJ.  Localization of a molecule immunochemically similar to eosinophil major basic protein in human placenta. J Exp Med . 1984;;160:29-41.
11 +
Kimura T, Yasue H, Sakaino N, Rokutanda M, Jougasaki M, Araki H.  Effect of magnesium on the tone of isolated human coronary arteries: comparison with diltiazem and nitroglycerin. Circulation . 1989;;79:1118-1124.
12 +
Hertzman PA, Blevins WL, Mayer J, Greenfield B, Ting M, Gleich GJ.  Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan. N Engl J Med . 1990;;322:869-873.
13 +
Martin RW, Duffy J, Engel AG, et al.  The clinical spectrum of the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion: clinical features in 20 patients and aspects of pathophysiology. Ann Intern Med . 1990;;113:124-134.
14 +
Ackerman SJ, Kephart GM, Francis K, Awadzi K, Gleich GJ, Ottesen EA.  Eosinophil degranulation: an immunologic determinant in the pathogenesis of the Mazzotti reaction in human onchocerciasis. J Immunol . 1990;;144:3961-3969.
15 +
Tai P-C, Ackerman SJ, Spry CJF, Dunnette S, Olsen EGJ, Gleich GJ.  Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease. Lancet. 1987;;1:643-647.
16 +
Tai P-C, Haydes DJ, Clark JB, Spry CJF.  Toxic effects of human eosinophil secretion products on isolated rat heart cells in vitro. Biochem J . 1983;; 204:75-80.
17 +
DeMello DE, Liapis R, Jureidini S, Nouri S, Kephart GM, Gleich GJ.  Cardiac localization of eosinophil-granule major basic protein in acute necrotizing myocarditis. N Engl J Med . 1990;;323:1542-1545.
18 +
Gundel RH, Letts LG, Gleich GJ.  Human eosinophil major basic protein induces airway constriction and airway hyperresponsiveness in primates. J Clin Invest . 1991;;87:1470-1473.
19 +
Rohrbach MS, Wheatly CL, Slifman NR, Gleich GJ.  Activation of platelets by eosinophil granule ule proteins. J Exp Med . 1990;;172:1271-1274.
20 +
James TN, Kamb ML, Sandberg GA, Silver PM, Kilbourne EM.  Postmortem studies of the heart in three fatal cases of the eosinophilia-myalgia syndrome. Ann Intern Med . 1991;;18:1367-1379.
21 +
Waters D, Szlachcic J, Miller D, Theroux P.  Clinical characteristics of patients with variant angina complicated by myocardial infarction or death within 1 month. Am J Cardiol . 1982;;49:658-664.
22 +
Nakamura M, Takeshita A, Nose Y.  Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina. Circulation . 1987;;75:1110-1116.

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1 +
Hertzman A, Falk H, Kilbourne EM, Page S, Shulman LE.  The eosinophilia-myalgia syndrome: the Los Alamos Conference. J Rheumatol . 1991;; 18:867-873.
2 +
Swygert LA, Maes EF, Sewell LE, Miller L, Falk E, Kilbourne EM.  Eosinophilia-myalgia syndrome: results of national surveillance. JAMA . 1990;; 264:1698-1703.
3 +
Kaufman LE, Gruber BL, Gregersen PK.  Clinical follow-up and immunogenetic studies of 32 patients with eosinophilia-myalgia syndrome. Lancet . 1991;;337:1071-1074.
4 +
Kalsner S, Richards R.  Coronary arteries of cardiac patients are hyperreactive and contain stores of amines: a mechanism for coronary artery spasm. Science . 1984;;223:1435-1437.
5 +
Giuliani E, Fuster V, Gersh B, McGoon M, McGoon D. Cardiology: Fundamentals and Practice . 2nd ed. St Louis, Mo: Mosby—Year Book; 1991;:1309.
6 +
Hirakawa Y, Koyanagi S, Matsumoto T, Takeshita A, Nakamura M.  A case of variant angina associated with eosinophilia. Am J Med . 1989;;87: 472-474.
7 +
Silver RM, Heyes MP, Maize JC, Quearry B, Vionnet-Fuasset M, Sternberg EM.  Scleroderma, fasciitis, and eosinophilia associated with ingestion of L-tryptophan. N Engl J Med . 1990;;322:874-881.
8 +
Filley WV, Holley KE, Kephart GM, Gleich GJ.  Identification by immunofluorescence of eosinophil granule major basic protein in lung tissues of patients with bronchial asthma. Lancet . 1982;;2:11-16.
9 +
Peters MS, Schroeter AL, Kephart GM, Gleich GJ.  Localization of eosinophil granule major basic protein in chronic urticaria. J Invest Dermatol . 1983;; 81:39-43.
10 +
Maddox DE, Kephart GM, Cuolam CB, Butterfield JH, Benirschke K, Gleich GJ.  Localization of a molecule immunochemically similar to eosinophil major basic protein in human placenta. J Exp Med . 1984;;160:29-41.
11 +
Kimura T, Yasue H, Sakaino N, Rokutanda M, Jougasaki M, Araki H.  Effect of magnesium on the tone of isolated human coronary arteries: comparison with diltiazem and nitroglycerin. Circulation . 1989;;79:1118-1124.
12 +
Hertzman PA, Blevins WL, Mayer J, Greenfield B, Ting M, Gleich GJ.  Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan. N Engl J Med . 1990;;322:869-873.
13 +
Martin RW, Duffy J, Engel AG, et al.  The clinical spectrum of the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion: clinical features in 20 patients and aspects of pathophysiology. Ann Intern Med . 1990;;113:124-134.
14 +
Ackerman SJ, Kephart GM, Francis K, Awadzi K, Gleich GJ, Ottesen EA.  Eosinophil degranulation: an immunologic determinant in the pathogenesis of the Mazzotti reaction in human onchocerciasis. J Immunol . 1990;;144:3961-3969.
15 +
Tai P-C, Ackerman SJ, Spry CJF, Dunnette S, Olsen EGJ, Gleich GJ.  Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease. Lancet. 1987;;1:643-647.
16 +
Tai P-C, Haydes DJ, Clark JB, Spry CJF.  Toxic effects of human eosinophil secretion products on isolated rat heart cells in vitro. Biochem J . 1983;; 204:75-80.
17 +
DeMello DE, Liapis R, Jureidini S, Nouri S, Kephart GM, Gleich GJ.  Cardiac localization of eosinophil-granule major basic protein in acute necrotizing myocarditis. N Engl J Med . 1990;;323:1542-1545.
18 +
Gundel RH, Letts LG, Gleich GJ.  Human eosinophil major basic protein induces airway constriction and airway hyperresponsiveness in primates. J Clin Invest . 1991;;87:1470-1473.
19 +
Rohrbach MS, Wheatly CL, Slifman NR, Gleich GJ.  Activation of platelets by eosinophil granule ule proteins. J Exp Med . 1990;;172:1271-1274.
20 +
James TN, Kamb ML, Sandberg GA, Silver PM, Kilbourne EM.  Postmortem studies of the heart in three fatal cases of the eosinophilia-myalgia syndrome. Ann Intern Med . 1991;;18:1367-1379.
21 +
Waters D, Szlachcic J, Miller D, Theroux P.  Clinical characteristics of patients with variant angina complicated by myocardial infarction or death within 1 month. Am J Cardiol . 1982;;49:658-664.
22 +
Nakamura M, Takeshita A, Nose Y.  Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina. Circulation . 1987;;75:1110-1116.

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