A 38 year old woman with hypotensive shock at the onset of menstruation: case outcome

doi:10.1136/bmj.b247

Published 9 March 2009, doi:10.1136/bmj.b247
Cite this as: BMJ 2009;338:b247

Practice

A 38 year old woman with hypotensive shock at the onset of menstruation: case outcome

Sergio Serrano Villar, resident in internal medicine¹, Juncal Perez-Somarriba, consultant in internal medicine ¹, Talia Sainz Costa, resident in paediatrics¹, Sarah Winstanley, foundation doctor², Tomas Santillana Lopez, consultant in internal medicine¹, Luis Escribano Mora, consultant in haematology³, Baltasar Orejas Gonzalez, professor in internal medicine¹

¹ Hospital Clinico San Carlos, Madrid 28040, Spain, ² Kingston Hospital, London, ³ Centro de Estudios de Mastocitosis de Castilla la Mancha, Hospital Virgen del Valle, Toledo, Spain

Correspondence to: S Serrano Villar sergio1serrano@yahoo.es

doi:10.1136/bmj.b799doi:10.1136/bmj.b796doi:10.1136/bmj.b846doi:10.1136/bmj.b867doi:10.1136/bmj.b868

The first 150 words of the full text of this article appear below.

Four weeks ago (BMJ 2009;338:b6, doi:10.1136/bmj.b6) we presentedthe case of Mrs Barroso who presented with serious hypotensiveshock triggered by the onset of menstruation. All investigationswere negative, except for retroperitoneal fibrosis and periaorticadenopathies found on computed tomography (BMJ 2009;338:b246,doi:10.1136/bmj.b246).

Subsequently, we measured her serum tryptase concentration,which was 30 µg/l (normal range <12 µg/l. Tryptaseis an endoprotease exclusively present in mast cells; henceit is a sensitive marker of conditions in which mast cells areimplicated, such as anaphylaxis and mastocytosis.

A bone marrow biopsy sample showed normocellularity and multifocalaggregates of abnormal spindle shaped mast cells (figs 1, 2,and 3). Mutation of codon 816 (D816V) was positive in the c-kitgene of mast cells. This gene codes for tyrosine kinase, whichis essential for normal development and expansion of mast cells,and activation mutations . . . [Full text of this article]

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