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

doi:10.1136/bmj.b247

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

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

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

Correspondence to: S Serrano Villar sergio1serrano{at}yahoo.es

Accepted 7 October 2008

Four weeks ago (BMJ 2009;338:b6, doi:10.1136/bmj.b6) we presented the case of Mrs Barroso who presented with serious hypotensive shock triggered by the onset of menstruation. All investigations were negative, except for retroperitoneal fibrosis and periaortic adenopathies 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. Tryptase is an endoprotease exclusively present in mast cells; hence it is a sensitive marker of conditions in which mast cells are implicated, such as anaphylaxis and mastocytosis.

A bone marrow biopsy sample showed normocellularity and multifocal aggregates of abnormal spindle shaped mast cells (figs 1⇓, 2⇓, and 3⇓). Mutation of codon …