Published 11 March 2009, doi:10.1136/bmj.b1012
Cite this as: BMJ 2009;338:b1012

Editor's Choice

Interactive case reports

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

You’ll find the outcome of our latest interactive case report in this week’s journal (doi:10.1136/bmj.b247). Congratulations to Petros Rafailidis in Athens for reaching the correct diagnosis after we published the second part of the case a few weeks ago. The 38 year old woman who suffered recurrent collapses with the onset of menstruation did not have adrenal insufficiency as many of you thought. Our expert commentator Paul van Daele was also drawn to that diagnosis by the patient’s rapid response to steroids and lack of response to vasoactive drugs, which seemed to rule out anaphylaxis (doi:10.1136/bmj.b846). But anaphylaxis it was, caused by systemic mastocytosis.

This is a rare case. Indeed, the authors believed it to be the first report of menstruation triggering the release of mast cell mediators. But one rapid respondent, Robert Berstein, found two other reports by Googling "hypotensive menstruation." Google, that great diagnostic . . . [Full text of this article]

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