J. Varga, J. Peltonen, J. Uitto, S. Jimenez, "Development of diffuse fasciitis with eosinophilia during L-tryptophan treatment: Demonstration of elevated type I collagen gene expression in affected tissues," Annals of Internal Medicine, 112:344-51, 1990.

John Varga and Sergio Jimenez (Jefferson Medical College, Philadelphia): "In November 1989, the Centers for Disease Control alerted the medical community to a nationwide epidemic of a previously unrecognized illness associated with ingestion of over-the-counter L-tryptophan: eosinophilia-myalgia syndrome (EMS). Our paper called attention to the inflammation and fibrosis of subcutaneous fascia as one of the most important pathologic features of the syndrome. Our results, indicating high levels of Type I collagen mRNA in affected tissue fibroblasts, suggested that activation of extracellular matrix gene expression is an important element in the pathogenesis of EMS. Because of the topographic proximity of fibroblasts displaying elevated expression of collagen genes to infiltrating inflammatory cells, we suggested that fibroblast activation may...

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