Elevated L-kynurenine level and its normalization by prednisolone in a patient with eosinophilia-myalgia syndrome.
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| Abstract |
We report a L-tryptophan-induced case of eosinophilia-myalgia syndrome in a Japanese woman and describe the time course of changes in tryptophan metabolism observed during steroid therapy. She had taken 1.0 g of the implicated L-tryptophan daily. When admitted due to painful swelling of her extremities, eosinophil count was 22.3 x 10(9)/L. Before prednisolone treatment, her serum L-kynurenine level was 10.2 mumol/L, a level about three-fold higher than the normal value, while serum tryptophan level was abnormally low (23.1 mumol/L). On the 14th day of prednisolone treatment (40 mg daily), L-kynurenine was declined to 8.1 mumol/L and, concomitantly, L-tryptophan level increased to the normal range (51.0 mumol/L). Subsequently, on the 42nd day of therapy, serum L-kynurenine was normalized. In contrast, serum serotonin level was unchanged throughout the course of this therapy. Prednisolone dramatically reduced the elevated serum L-kynurenine with a reciprocal increase in serum L-tryptophan indicates that abnormal tryptophan metabolism, may play a role in the pathogenesis of eosinophilia myalgia syndrome, and that the observed effect of steroid treatment was due to suppression of elevated activity of indoleamine 2, 3-dioxygenase, a first rate-limiting enzyme of the kynurenine pathway.
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| Authors | A Hisatomi, A Kubota, M Ohashi, F Umeda, H Nawata, T Imamura, T Nagata |
| Journal | Fukuoka igaku zasshi = Hukuoka acta medica (Fukuoka Igaku Zasshi) Vol. 88 Issue 1 Pg. 11-7 (Jan 1997) ISSN: 0016-254X [Print] Japan |
| PMID | 9037890 (Publication Type: Case Reports, Journal Article) |
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