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Choudhary S, Srivastava A, Joshi D, Tummudi S. Localized Grain-Leather Plaque in Urticaria Pigmentosa - An Unusual Coexistence of Dual Morphology. Indian Dermatol Online J 2020; 11:796-798. [PMID: 33235849 PMCID: PMC7678550 DOI: 10.4103/idoj.idoj_540_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 11/04/2022] Open
Abstract
Urticaria pigmentosa (UP), the most common variant of cutaneous mastocytosis (CM), is characterized by hyperpigmented, brownish macules and patches, with positive Darier's sign. Diffuse cutaneous mastocytosis (DCM), is a rare variant of CM, characterized by diffuse infiltration of the skin by mast cells (MCs), resulting in a typical grain-leather appearance. Blistering is commonly seen in infants with CM but it is not specific for any variant of CM. Herein, we report a case of a 5-month-old male infant who presented with recurrent bullous lesions and hyperpigmented, brownish patches with intervening normal skin suggestive of UP, as well as a single, localized plaque with grain-leather appearance, thereby exhibiting an interesting dual morphology.
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Affiliation(s)
- Sanjiv Choudhary
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ankita Srivastava
- Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Deepti Joshi
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Santosh Tummudi
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
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Conde-Fernandes I, Sampaio R, Moreno F, Palla-Garcia J, Teixeira MDA, Freitas I, Neves E, Jara-Acevedo M, Escribano L, Lima M. Systemic mastocytosis with KIT V560G mutation presenting as recurrent episodes of vascular collapse: response to disodium cromoglycate and disease outcome. Allergy Asthma Clin Immunol 2017; 13:21. [PMID: 28439288 PMCID: PMC5402055 DOI: 10.1186/s13223-017-0193-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/06/2017] [Indexed: 01/08/2023] Open
Abstract
Background Mastocytosis are rare diseases characterized by an accumulation of clonal mast cells (MCs) in one or multiple organs or tissues. Patients with systemic mastocytosis (SM), whose MCs frequently arbor the activating D816V KIT mutation, may have indolent to aggressive diseases, and they may experience MC mediator related symptoms. Indolent SM with recurrent anaphylaxis or vascular collapse in the absence of skin lesions, ISMs(−), is a specific subtype indolent SM (ISM), and this clonal MC activation disorder represents a significant fraction of all MC activation syndromes. The V560G KIT mutation is extremely rare in patients with SM and its biological and prognostic impact remains unknown. Case presentation A 15-year old boy was referred to our hospital because of repeated episodes of flushing, hypotension and syncope since the age of 3-years, preceded by skin lesions compatible with mastocytosis on histopathology that had disappeared in the late-early childhood. Diagnosis of ISM, more precisely the ISMs(−) variant, was confirmed based on the clinical manifestations together with increased baseline serum tryptase levels and the presence of morphologically atypical, mature appearing (CD117+high, FcεRI+) phenotypically aberrant (CD2+, CD25+) MCs, expressing activation-associated markers (CD63, CD69), in the bone marrow. Molecular genetic studies revealed the presence of the KIT V560G mutation in bone marrow MCs, but not in other bone marrow cells, whereas the screening for mutations in codon 816 of KIT was negative. The patient was treated with oral disodium cromoglycate and the disease had a favorable outcome after an eleven-year follow-up period, during which progressively lower serum tryptase levels together with the fully disappearance of all clinical manifestations was observed. Conclusions To the best of our knowledge this first report of a patient with ISM, whose bone marrow MCs carry the KIT V560G activating mutation, manifesting as recurrent spontaneous episodes of flushing and vascular collapse in the absence of skin lesions at the time of diagnosis, in whom disodium cromoglycate had led to long term clinical remission.
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Affiliation(s)
- Iolanda Conde-Fernandes
- Consulta Multidisciplinar de Linfomas Cutâneos e Mastocitoses (CMLC), Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal.,Serviço de Dermatologia, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Rita Sampaio
- Serviço de Anatomia Patológica, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Filipa Moreno
- Serviço de Anatomia Patológica, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - José Palla-Garcia
- Serviço de Anatomia Patológica, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal
| | - Maria Dos Anjos Teixeira
- Laboratório de Citometria, Serviço de Hematologia Clínica, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Ex-CICAP, Rua D. Manuel II, s/n, 4099-001 Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas da Universidade do Porto (UMIB/ICBAS/UP), Porto, Portugal
| | - Inês Freitas
- Serviço de Hematologia Laboratorial, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas da Universidade do Porto (UMIB/ICBAS/UP), Porto, Portugal
| | - Esmeralda Neves
- Serviço de Imunologia, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas da Universidade do Porto (UMIB/ICBAS/UP), Porto, Portugal
| | - Maria Jara-Acevedo
- Servicio General de Citometría, Instituto de Biología Molecular y Celular del Cáncer, Centro de Investigación del Cáncer, Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca (IBMCC-CSIC/USAL), Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo, Spain
| | - Luis Escribano
- Servicio General de Citometría, Instituto de Biología Molecular y Celular del Cáncer, Centro de Investigación del Cáncer, Salamanca, Spain.,Departamento de Medicina, Universidad de Salamanca (IBMCC-CSIC/USAL), Salamanca, Spain.,Spanish Network on Mastocytosis (REMA), Toledo, Spain
| | - Margarida Lima
- Consulta Multidisciplinar de Linfomas Cutâneos e Mastocitoses (CMLC), Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal.,Laboratório de Citometria, Serviço de Hematologia Clínica, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Ex-CICAP, Rua D. Manuel II, s/n, 4099-001 Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas da Universidade do Porto (UMIB/ICBAS/UP), Porto, Portugal
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