12 vertebral body fractures and coincident skin changes
At the age of 40, the 57-year-old patient developed itchy, brownish-red maculopapular skin lesions on the skin Upper thighs (positive Darier sign), which have persisted in varying degrees since then. The suspicion of urticaria pigmentosa was expressed, but there was no further therapy recommendation. At the age of 51, femoral neck fracture and four vertebral body fractures occurred without adequate trauma and without further risk factors. Osteoporosis was diagnosed and treated with stronzium ranelate. At the age of 57, fractures ranging from 6 to 5 levels with three-fold increased serum tryptase were found. The results of the biopsies of skin and bone marrow met the WHO criteria for systemic mastocytosis (major: multifocal mast cell infiltrates, minor: spindle-shaped mast cells, expression CD25 and CD2, kit mutation, serum tryptase value). The patient was treated with 4 mg zoledronate every six months. After one year, no further sintering fractures were detectable. Systemic mastocytosis can stimulate cytokine-mediated osteoclasts and lead to osteoporosis. Aetiologically unclear osteoporosis (young age, no risk factors) requires extensive clarification. Systemic mastocytosis should also be considered.
Dr. med. Martin Gehlen, Dr. Ana Doina Lazarescu, Christian Hinz , Der Fürstenhof Clinic, Specialist Clinic for Rheumatology, Orthopedics and Osteology, Clinical Osteological Focus Center and Osteological Research Center DVO, Bad Pyrmont, firstname.lastname@example.org
Conflict of interest The authors declare that there is no conflict of interest.
Citation Gehlen M, Lazarescu AD, Hinz C: 12 vertebral-body fractures and simultaneous skin changes. Dtsch Arztebl Int 2018; 115: 418 . DOI: 10.3238 / arztebl.2018.0418
►Enlarged image and English translation at: www.