Clinical signs and symptoms:
(1) fever
(2) myalgia severe enough to cause functional impairment
(3) skin rash with pruritis
(4) arthralgias
(5) dyspnea
(6) paresthesias
(7) scleroderma-like skin changes
(8) eosinophilic fasciitis
(9) malaise and fatigue
(10) alopecia
(11) mouth ulcers
(12) cognitive problems (impaired memory, difficulty concentrating, other)
(13) anxiety and/or depression
Laboratory findings:
(1) eosinophilia
(2) elevated liver function tests
The diagnosis was made based on:
(1) a history of taking L-tryptophan from affected production lots
(2) exclusion of other diagnoses
(3) gradual resolution once ingestion of L-tryptophan has been stopped
