Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Systemic mastocytosis
- Petros I. Rafailidis (19 February 2009)
-
Possible Differentials
- Akin M Fafunso (25 February 2009)
-
? mast cell disease
- Thein H Oo (3 March 2009)
-
Toxic shock syndrome
- Massimo Bolognesi (7 March 2009)
-
Recurrent collapse and hypotension
- Plutarco Elias Chiquito (11 March 2009)
-
Re: Toxic shock syndrome
- Martin Ferry (11 March 2009)
|
|
|||
|
Petros I. Rafailidis, Specialist in Internal Medicine Athens, Greece
Send response to journal:
|
This patient most likely has systemic mastocytosis (± associated clonal hematologic non-mast-cell lineage disease). Bone marrow aspiration and biopsy will establish the diagnosis [major criterion (WHO criteria) for systemic mastocytosis: multifocal dense aggregates (>15) of mast cells and confirmed by tryptase immunohistochemistry or other stains]. In addition WHO minor criteria for systemic mastocytosis can be documented as well in the bone marrow examination such as: >25% atypical morphology of the mast cells, detection of KIT point mutation in bone marrow (or blood), mast cell co-expression of CD117, CD2 and or CD25. Serum tryptase levels should be measured as well (abnormal if >20ng/ml). Competing interests: None declared |
|||
|
|
|||
|
Akin M Fafunso, GP Reg London
Send response to journal:
|
1) Zollinger-Ellison syndrome or one of the MEN syndromes 2) Could her symptoms be paraneoplastic manifestations of an occult malignancy?...there is a strong family hx of cancer. Competing interests: None declared |
|||
|
|
|||
|
Thein H Oo, Attending Physician/Consultant in Hematology & Oncology St Elizabeth's Medical Center, Boston, USA
Send response to journal:
|
I will check serum tryptase level. If it is high (e.g.> 20ng/ml), then I will proceed to bone marrow biopsy to look for dense mast cell infiltrates. This can be supplemented by flow cytometric studies. Competing interests: None declared |
|||
|
|
|||
|
Massimo Bolognesi, Internal General Medicine 47023 Cesena Italy
Send response to journal:
|
Toxic shock syndrome (TSS) is an acute febrile and afebrile illness accompanied by diarrhea, vomiting, hypotension, and often multiple organ involvement. TSS was primarily associated with menstruation. Since then, the frequency of menstrual TSS has decreased dramatically. Toxic shock syndrome is a sudden, potentially fatal condition brought on by the release of toxins or poisonous substances from an overgrowth of a bacterium called Staphylococcus aureus, which is commonly found in many women. It is widely known to affect menstruating women, especially those who use superabsorbent tampons. Competing interests: None declared |
|||
|
|
|||
|
Plutarco Elias Chiquito, Staff Physician, Emergency Medicine Erne Hospital, Enniskillen, Northern Ireland BT74 6AY
Send response to journal:
|
This is a very interesting and challenging case and must have been frustrating for the physicians treating a frightened and anxious patient with recurrent collapse without a definitive diagnosis or treatment. The history of collapse and hypotension responsive to a bolus dose of steroids suggests primary adrenal insufficiency. Life threatening adrenal crisis can present with hypotension or shock, as an acute abdomen or sometimes as sepsis with or without fever. Less severe presentations are often insidious with non-specific symptoms. Random cortisol levels are often unhelpful and adrenal stimulation with the short synacthen test can be normal in the early stages of the disease. Therefore, I would strongly consider repeating this test. Anaphylaxis has been mentioned and a serum tryptase level could had been helpful in ruling out this condition. Reference Arlt W, Allolio B. Adrenal insufficiency. The Lancet; 361: 1881-1893 Competing interests: None declared |
|||
|
|
|||
|
Martin Ferry, Student G20
Send response to journal:
|
According to the BMJ website, rapid responses should be regarded as letters to the editor. As such there's a reasonable expectation from readers that contributions are prepared in accordance with standard conventions. Dr Bolognesi's contribution bears a striking similarity to the text found on this patient information website: http://www.hipusa.com/webmd/encyclopedia/toxic_shock_syndrome/index.html. Extensive verbatim quotation of such sources should perhaps be acknowledged to avoid any confusion over the origin of text posted on this forum. Competing interests: None declared |
|||