phosphocreatine and Eosinophilia-Myalgia-Syndrome

We describe a patient with the eosinophilia-myalgia syndrome (EMS) with persistent myalgias, cramping, and weakness that were not responsive to treatment. Despite a normal serum magnesium level, a loading study was performed, and the results suggested low tissue levels of magnesium. He was given parenteral magnesium and had dramatic improvement in symptoms as well as in muscle intracellular levels of this cation. After cessation of magnesium therapy the symptoms recurred, and magnesium repletion again led to an improvement in symptoms and ATP levels. Low tissue levels of magnesium, even in the setting of normal serum levels, may lead to the neuromuscular symptoms in EMS and related disorders.

Topics: Adenosine Triphosphate; Adult; Eosinophilia-Myalgia Syndrome; Humans; Infusions, Parenteral; Magnesium; Magnesium Deficiency; Magnetic Resonance Spectroscopy; Male; Muscles; Osmolar Concentration; Phosphocreatine; Phosphorus

To determine the pathogenesis of muscular symptomatology in the eosinophilia-myalgia syndrome (EMS).. P31-nuclear magnetic resonance spectroscopy (MRS) was performed on 7 patients with EMS and 10 age matched controls to determine the relative concentrations of phosphocreatine (PCr), inorganic phosphate (Pi), and adenosine triphosphate (ATP) in calf muscle.. Patients with EMS had statistically lower ATP/PCr ratios and higher Pi/ATP ratios than controls, indicating a preferential and unique decrease in ATP levels at rest in skeletal muscle.. Skeletal muscle is metabolically abnormal in patients with EMS. This abnormality may contribute to the myalgia, spasm, and weakness seen in this disorder.

Topics: Adenosine Triphosphate; Adult; Eosinophilia-Myalgia Syndrome; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Muscles; Phosphates; Phosphocreatine; Phosphorus