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Rydz A, Lange M, Ługowska-Umer H, Sikorska M, Nowicki RJ, Morales-Cabeza C, Alvarez-Twose I. Diffuse Cutaneous Mastocytosis: A Current Understanding of a Rare Disease. Int J Mol Sci 2024; 25:1401. [PMID: 38338679 PMCID: PMC11154339 DOI: 10.3390/ijms25031401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Mastocytosis is a heterogeneous disease characterized by the expansion and accumulation of neoplastic mast cells in various tissues. Diffuse cutaneous mastocytosis (DCM) is a rare and most severe form of cutaneous mastocytosis, which typically occurs in childhood. There have been reports of a familial DCM with specific gene mutations, indicating both sporadic and hereditary factors involved in its pathogenesis. DCM is associated with severe MC mediator-related symptoms and an increased risk of anaphylaxis. The diagnosis is based on the appearance of skin lesions, which typically show generalized thickening, erythroderma, blistering dermographism, and a positive Darier's sign. Recognition, particularly in infants, is challenging due to DCMs resemblance to other bullous skin disorders. Therefore, in unclear cases, a skin biopsy is crucial. Treatment focuses on symptom management, mainly including antihistamines and mast cell stabilizers. In extremely severe cases, systemic steroids, tyrosine kinase inhibitors, phototherapy, or omalizumab may be considered. Patients should be equipped with an adrenaline autoinjector. Herein, we conducted a comprehensive review of literature data on DCM since 1962, which could help to better understand both the management and prognosis of DCM, which depends on the severity of skin lesions, intensity of mediator-related symptoms, presence of anaphylaxis, and treatment response.
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Affiliation(s)
- Agnieszka Rydz
- Student’s Scientific Circle Practical and Experimental Dermatology, Medical University of Gdansk, 80-211 Gdańsk, Poland;
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Hanna Ługowska-Umer
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Monika Sikorska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (H.Ł.-U.); (M.S.); (R.J.N.)
| | - Cristina Morales-Cabeza
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain; (C.M.-C.); (I.A.-T.)
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast)—Spanish Reference Center for Mastocytosis, Hospital Virgen del Valle—Complejo Hospitalario Universitario de Toledo, 45071 Toledo, Spain; (C.M.-C.); (I.A.-T.)
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2
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Olteanu EG, Bataneant M, Puiu M, Chirita-Emandi A. When Mast Cells Run Amok: A Comprehensive Review and Case Study on Severe Neonatal Diffuse Cutaneous Mastocytosis. Genes (Basel) 2023; 14:2021. [PMID: 38002964 PMCID: PMC10671269 DOI: 10.3390/genes14112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Neonatal diffuse cutaneous mastocytosis (NDCM) is defined as the infiltration of the epidermis by a clonal proliferation of mast cells, observed at birth, without initial signs of systemic involvement. The typical driver mutation is in the KIT gene. We report a rare case of a boy, born at term, already presenting at birth with generalized subcutaneous nodules on the face, scalp, trunk, back, hands, and feet. The spleen, liver, and inflammatory markers were normal at birth. Tryptase was significantly elevated. A bone marrow biopsy showed no mast cell involvement at age 2 months. A punch biopsy at age 2 months revealed CD117-positive cells diffusely infiltrating the skin, with subsequent DNA NGS sequencing for the formalin-fixed paraffin embedded tissue (FFPE) identifying the pathogenic NM_000222.3:c.1504_1509dup; p.(Ala502_Tyr503dup) variant in the KIT gene previously associated with cutaneous mastocytosis. At 2 years follow-up, he had splenomegaly and multiple cervical and inguinal adenopathy, while the skin nodules persisted, especially on the scalp with accompanying pruritus. He received oral and local sodium cromoglycate, oral antihistamines, antibiotic cream for skin infection, and iron supplementation; however, compliance to treatment was relatively low. The prognosis is difficult to predict, as he developed systemic involvement, failure to thrive, and mild psychomotor delay. A case aggregation of NDCM reported in the literature was performed to provide a comprehensive overview of this rare pathology, to better understand the prognosis. NDCM is a life-threatening disease with severe complications. Almost half had severe complications, such as mast hepatosplenomegaly, adenopathy, bacterial infections, mast cell leukaemia, and systemic involvement.
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Affiliation(s)
- Emilian-Gheorghe Olteanu
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Piaţa Eftimie Murgu Nr. 2, 300041 Timisoara, Romania;
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihaela Bataneant
- Discipline of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Oncology and Hematology, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
| | - Maria Puiu
- Discipline of Genetics and Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.P.); (A.C.-E.)
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
| | - Adela Chirita-Emandi
- Discipline of Genetics and Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.P.); (A.C.-E.)
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, 300041 Timisoara, Romania
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3
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Larouche V, Paré MF, Grenier PO, Wieckowska A, Gagné E, Laframboise R, Jabado N, De Bie I. A Review of the Clinical Features and Management of Systemic Congenital Mastocytosis through the Presentation of An Unusual Prenatal-Onset Case. Curr Oncol 2023; 30:8992-9003. [PMID: 37887549 PMCID: PMC10605361 DOI: 10.3390/curroncol30100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023] Open
Abstract
Mastocytosis is a heterogeneous group of rare hematological disorders that can occur in infancy. We report a 16-year-old girl who presented with an aggressive form of systemic congenital mastocytosis, associated with a significant global developmental delay, deafness, and multiple anomalies. At 4 years of age, she developed a germinoma presenting as an invasive spinal mass. Extensive cytogenetic, metabolic, and molecular genetic studies that included whole-exome sequencing studies revealed a KIT alteration (NM_000222.3(KIT):c2447A > 7 pAsp816Val) and likely pathogenic variant in the DNA from peripheral blood and skin lesions. C-kit was also found to be overexpressed in the spinal tumor cells. We compared the features of this child to those of six previously reported pediatric patients with cutaneous mastocytosis, microcephaly, microtia, and/or hearing loss reported in OMIM as mastocytosis, conductive hearing loss, and microtia (MIM 248910), for which the etiology has not yet been determined. This report extends the currently recognized spectrum of KIT-related disorders and provides clues as to the potential etiology of a syndromic form of congenital mastocytosis. International efforts to understand the benefits of long-term targeted therapy with tyrosine kinase inhibitors for this KIT-altered rare disease should continue to be evaluated in clinical trials.
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Affiliation(s)
- Valérie Larouche
- Department of Pediatric Hemato-oncology, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec, QC G1V4G2, Canada
| | | | - Pierre-Olivier Grenier
- Department of Dermatology, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec, QC G1V4G2, Canada
| | - Anna Wieckowska
- Departement of Pediatric, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec, QC G1V4G2, Canada
| | - Eric Gagné
- Department of Pathology, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec, QC G1V4G2, Canada
| | - Rachel Laframboise
- Department of Medical Genetics, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec, QC G1V4G2, Canada
| | - Nada Jabado
- Department of Pediatric Hemato-Oncology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC G1V4G2, Canada
| | - Isabelle De Bie
- Division of Medical Genetics, Department of Specialized Medicine, McGill University Health Centre, Montreal, QC G1V4G2, Canada
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4
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Cuperus E, Bygum A, Boeckmann L, Bodemer C, Bolling MC, Caproni M, Diociaiuti A, Emmert S, Fischer J, Gostynski A, Guez S, van Gijn ME, Hannulla-Jouppi K, Has C, Hernández-Martín A, Martinez AE, Mazereeuw-Hautier J, Medvecz M, Neri I, Sigurdsson V, Suessmuth K, Traupe H, Oji V, Pasmans SGMA. Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma. J Eur Acad Dermatol Venereol 2022; 36:973-986. [PMID: 35238435 PMCID: PMC9310754 DOI: 10.1111/jdv.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.
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Affiliation(s)
- E Cuperus
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| | - A Bygum
- University of Southern Denmark, Clinical Institute, Denmark & Odense University Hospital, Department of Clinical Genetics, Denmark
| | - L Boeckmann
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP5), Paris-Centre University, Imagine Institute, INSERM, Paris, France
| | - M C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, USL Toscana Centro, Rare Diseases Unit, University of Florence, Florence, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Emmert
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Gostynski
- Department of Dermatology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Guez
- Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M E van Gijn
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - K Hannulla-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - A E Martinez
- Pediatric Dermatology, NHS Foundation Trust, Great Ormond Street, London, UK
| | - J Mazereeuw-Hautier
- Dermatology Department, Reference Center for Rare Skin Diseases, Toulouse, France
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - I Neri
- Dermatology - IRCCS Policlinico di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater, Studiorum University of Bologna, Bologna, Italy
| | - V Sigurdsson
- University Medical Center Utrecht and Utrecht University, Department of Dermatology, Utrecht, The Netherlands
| | - K Suessmuth
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - S G M A Pasmans
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
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Abstract
PURPOSE OF REVIEW The current article highlights recent developments in the field of pediatric cutaneous mastocytosis. Mastocytosis is a spectrum of conditions that range from fleetingly benign to aggressively malignant. Through recognizing the natural progression of disease, the role of biomarkers and mutational analysis, treatment and risk of triggers, physicians can confidently stage, counsel and manage patients with pediatric cutaneous mastocytosis. RECENT FINDINGS Many lesions of cutaneous mastocytosis are chronic with some resolving around the mid-teenage years. KIT mutations are found in the majority of pediatric cutaneous mastocytosis but are not correlated with prognosis. Serum tryptase levels may be elevated in pediatric cutaneous mastocytosis patients without systemic mastocytosis. Pimecrolimus, omalizumab and tyrosine kinase inhibitors are effective treatment options. The low risk of NSAIDs and vaccinations has been characterized and epinephrine autoinjectors are rarely utilized in the pediatric cutaneous mastocytosis patient. SUMMARY Pediatric cutaneous mastocytosis is a heterogeneous disease with good outcome overall. Organomegaly, elevated tryptase levels and the presence of KIT mutation in peripheral blood may aid in the decision to pursue bone marrow biopsy. The armamentarium of treatments has expanded and better understanding of the significance of triggers and vaccination safety allows the clinician to thoughtfully counsel and allay anxiety around pediatric cutaneous mastocytosis.
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6
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Pei S, Fischer AS, Castelo-Soccio L, Rubin AI. Multiple indurated plaques and a blister in a newborn. Pediatr Dermatol 2020; 37:e46-e48. [PMID: 32706468 DOI: 10.1111/pde.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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7
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Cardoso JM, Cabral CAS, Lellis RF, Ravelli FN. Bullous congenital diffuse cutaneous mastocytosis. An Bras Dermatol 2020; 95:255-256. [PMID: 32156504 PMCID: PMC7175041 DOI: 10.1016/j.abd.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/28/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Rute Facchini Lellis
- Sector of Dermatology, Department of Pathology, Hospital Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Flavia Naranjo Ravelli
- Department of Dermatology, Universidade de Santo Amaro, São Paulo, SP, Brazil; Department of Dermatology, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
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8
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Affiliation(s)
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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9
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c-KIT-Positive Fatal Diffuse Cutaneous Mastocytosis With Systemic Manifestations in a Neonate. J Pediatr Hematol Oncol 2019; 41:e338-e340. [PMID: 30067557 DOI: 10.1097/mph.0000000000001271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diffuse cutaneous mastocytosis is a rare variant of mastocytosis in the neonatal period. We describe a case of c-KIT (DV) mutation-positive fatal diffuse cutaneous mastocytosis with systemic involvement of the gastrointestinal tract and associated malabsorption and hepatosplenomegaly associated with mast cell mediator release symptoms.
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10
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Jenkinson HA, Lundgren AD, Carter MC, Diaz LZ, Levy ML. Management of a neonate with diffuse cutaneous mastocytosis: Case report and literature review. Pediatr Dermatol 2019; 36:486-489. [PMID: 30828864 DOI: 10.1111/pde.13801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mastocytosis is an accumulation of clonal mast cells within tissues, commonly caused by mutations in the KIT proto-oncogene. This report describes the management of a neonate with diffuse cutaneous mastocytosis (DCM) caused by a rare activating KIT mutation, specifically internal tandem duplication of the Ala502Tyr503 pair on exon 9, and reviews current data regarding work-up of DCM in pediatric patients.
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Affiliation(s)
- Helena A Jenkinson
- Department of Dermatology, McGovern Medical School at The University of Texas at Houston, Houston, Texas
| | - Ashley D Lundgren
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas
| | - Melody C Carter
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lucia Z Diaz
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas.,Department of Pediatrics, Dell Medical School, Austin, Texas
| | - Moise L Levy
- Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas.,Department of Pediatrics, Dell Medical School, Austin, Texas
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11
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Hosking AM, Makdisi J, Ortenzio F, de Feraudy S, Smith J, Linden K. Diffuse cutaneous mastocytosis: Case report and literature review. Pediatr Dermatol 2018; 35:e348-e352. [PMID: 30187958 DOI: 10.1111/pde.13651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 6-month-old boy was referred to our burn unit with a recurrent bullous dermatitis, fever, and emesis, originally diagnosed as staphylococcal scalded skin syndrome (SSSS) at an outside hospital. Infectious workup was negative and shave biopsy revealed a dense, diffuse dermal infiltrate of mast cells, consistent with diffuse cutaneous bullous mastocytosis-a rare variant of cutaneous mastocytosis. Treatment included a prolonged course of corticosteroids and antihistamines. Recognition of this rare form of mastocytosis is important, as it can be easily mistaken for other pediatric bullous diseases and is associated with life-threatening complications including vasodilation, anaphylactic shock, gastrointestinal bleeding, and death.
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Affiliation(s)
- Anna-Marie Hosking
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Joy Makdisi
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Francesca Ortenzio
- Department of Dermatology, University of California Irvine, Irvine, California
| | | | - Janellen Smith
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Kenneth Linden
- Department of Dermatology, University of California Irvine, Irvine, California
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12
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Mashiah J, Harel A, Bodemer C, Hadj-Rabia S, Goldberg I, Sprecher E, Kutz A. Topical pimecrolimus for paediatric cutaneous mastocytosis. Clin Exp Dermatol 2018; 43:559-565. [PMID: 29460435 DOI: 10.1111/ced.13391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most cases of paediatric cutaneous mastocytosis (CM) occur before the age of 2 years, and regression occurs in only 67% of children. Given the absence of any specific therapy, CM is usually treated symptomatically. A few publications have reported the beneficial effect of calcineurin inhibitors for CM. AIM We sought to evaluate the clinical effectiveness and safety profile of topical pimecrolimus cream for the treatment of CM. METHODS We performed a retrospective study of all diagnosed cases of CM treated with topical pimecrolimus 1% cream between 2013 and 2015. All patients were evaluated in a paediatric dermatology unit of a tertiary medical centre. Epidemiological, clinical and treatment data, including effectiveness and safety, were reviewed. RESULTS In total, 18 children (11 male, 7 female; age range 3-42 months) with CM were evaluated. Of the 146 treated lesions, 39 (26.7%) disappeared and 98 (67%) faded or developed postinflammatory hyperpigmentation. Of the 119 papular lesions, 24 (16.4%) showed partial flattening and 56 (47%) became macular. Darier sign became negative in 14 (82%) of 17 patients. No topical or systemic complications were observed. CONCLUSIONS Topical therapy with pimecrolimus 1% cream should be considered in the treatment of CM.
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Affiliation(s)
- J Mashiah
- Pediatric Dermatology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Harel
- Pediatric Dermatology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,INSERM 1163, Institut Imagine, Paris, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,INSERM 1163, Institut Imagine, Paris, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - I Goldberg
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Sprecher
- Pediatric Dermatology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kutz
- Pediatric Dermatology Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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13
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Hudson A, Finlayson L. Diffuse Cutaneous Bullous Mastocytosis and Disseminated Intravascular Coagulation Postvaccination: A Case Report. J Cutan Med Surg 2016; 20:596-599. [PMID: 27436822 DOI: 10.1177/1203475416661312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diffuse cutaneous bullous mastocytosis is the most rare subtype of cutaneous mastocytosis, characterized by generalized skin infiltration with mast cells and blistering. OBJECTIVE To increase the awareness of the natural history and potential adverse complications of this rare cutaneous condition. METHOD AND RESULTS We report a case of a male diagnosed on day 7 of life with follow-up of his progression over 6 years. When he was 2.5 months old, he was admitted to hospital postvaccinations with a flare of his blistering that was complicated by disseminated intravascular coagulation and polyuric acute tubular necrosis. Blistering ceased at 3 years, but at 6 years, extensive urtication continued in response to known triggers and a suboptimal dose of mast cell membrane stabilizers and histamine-1 and -2 receptor antagonists. CONCLUSION This case discusses the progression of this rare condition over 6 years and highlights the importance of reaching optimal pharmacologic blockage of histamine-1 and -2 receptors and stabilization of mast cell membranes in patients persistently experiencing ongoing pruritus, urtication, and flushing symptoms.
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Affiliation(s)
| | - Laura Finlayson
- Dalhousie Medicine, Halifax, Nova Scotia, Canada
- Division of Clinical Dermatology and Cutaneous Science, Halifax, Nova Scotia, Canada
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Górska A, Gruchała-Niedoszytko M, Niedoszytko M, Maciejewska A, Chełmińska M, Skrzypski M, Wasąg B, Kaczkan M, Lange M, Nedoszytko B, Pawłowski R, Małgorzewicz S, Jassem E. The Role of TRAF4 and B3GAT1 Gene Expression in the Food Hypersensitivity and Insect Venom Allergy in Mastocytosis. Arch Immunol Ther Exp (Warsz) 2016; 64:497-503. [PMID: 27086366 PMCID: PMC5085980 DOI: 10.1007/s00005-016-0397-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/27/2016] [Indexed: 12/13/2022]
Abstract
Mastocytosis is an uncommon disease classified as a myeloproliferative neoplasm, however, its symptoms are broad and place patients at crossroads between dermatology, hematology and allergology. Patients with mastocytosis often suffer from symptoms resulting from the activation and release of mediators from the mast cells, such as generalized itching, redness, headache, abdominal cramps, diarrhea, bone pain or arthritis, hypotension and shock. The possible severe, fatal or near fatal reactions caused by food hypersensitivity are reasons for the research focused on marker identification. The aim of the study was to analyse the gene expression differences in mastocytosis patients with and without food and drug hypersensitivity and insect venom allergy (IVA). A total of 57 Caucasian patients with mastocytosis were studied [median age 41.8; range 18–77 years; 15 (26.3 %) males and 42 (73.7 %) females]. Quantitative RT-PCRs of 11 genes plus ribosomal 18S RNA were run. Symptoms of food hypersensitivity were found in 12 patients (21 %), including 3 patients (13 %) with cutaneous mastocytosis (CM), and 9 (28 %) with indolent systemic mastocytosis (ISM). IVA was confirmed in 13 patients (22.8 %) including 6 patients (10.5 %) with CM, and 7 patients (12.3 %) with ISM. Drug hypersensitivity was diagnosed in 10 patients (17.5 %). Significant differences in the gene expression were found for TRAF4 (p = 0.008) in the comparison of the mastocytosis patients with and without concomitant food hypersensitivity. Furthermore significant differences were found in gene expression for B3GAT1 (p = 0.003) in patients with IVA compared to patients without insect sting anaphylaxis in the medical history. The expression of studied genes did not differ according to the presence of drug hypersensitivity. The TRAF4 expression was higher in mastocytosis patients with food hypersensitivity in their medical history, the B3GAT1 expression was lower in mastocytosis patients with IVA in history.
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Affiliation(s)
- Aleksandra Górska
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Marta Gruchała-Niedoszytko
- Department of Clinical Nutrition, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland.
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Marta Chełmińska
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Marcin Skrzypski
- Department of Oncology, Medical University of Gdansk, Gdańsk, Poland
| | - Bartosz Wasąg
- Department of Genetics, Medical University of Gdansk, Gdańsk, Poland
| | - Małgorzata Kaczkan
- Department of Clinical Nutrition, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Ryszard Pawłowski
- Department of Forensic Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland
| | - Ewa Jassem
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
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Wiechers T, Rabenhorst A, Schick T, Preussner LM, Förster A, Valent P, Horny HP, Sotlar K, Hartmann K. Large maculopapular cutaneous lesions are associated with favorable outcome in childhood-onset mastocytosis. J Allergy Clin Immunol 2015; 136:1581-1590.e3. [DOI: 10.1016/j.jaci.2015.05.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 12/27/2022]
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Slavescu KC, Chiorean R, Danescu S, Bota M, Rogojan L, Baican A. Diffuse cutaneous bullous mastocytosis with IgM deposits at dermo-epidermal junction. J Cutan Pathol 2015; 43:263-9. [DOI: 10.1111/cup.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/25/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kinga Cristina Slavescu
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Roxana Chiorean
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Sorina Danescu
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Madalina Bota
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Liliana Rogojan
- Department of Pathology; Emergency Clinical Hospital; Cluj-Napoca Romania
| | - Adrian Baican
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
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17
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Sperr WR, Valent P. Diagnosis, progression patterns and prognostication in mastocytosis. Expert Rev Hematol 2014; 5:261-74. [DOI: 10.1586/ehm.12.12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wawrzycki B, Pietrzak A, Chodorowska G, Kanitakis J. Diffuse cutaneous bullous mastocytosis in a newborn. Dermatol Ther 2013; 26:176-9. [PMID: 23551376 DOI: 10.1111/j.1529-8019.2013.01544.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diffuse cutaneous mastocytosis is the rarest subtype of mastocytosis among those that affect children. A 7-month-old girl presented at birth dry and thickened skin. On the second day of life, tense blisters appeared on erythrodermic areas and during the next days spread over the face, trunk, and limbs. The skin was bright red, had a "peau d'orange" appearance, and was considerably thickened with numerous translucent and hemorrhagic blisters. A skin biopsy revealed massive infiltration of the dermis with mast cells, leading to the diagnosis of diffuse erythrodermic mastocytosis. Systemic corticosteroids were given along with antihistamines with good results. Despite the progresses in the understanding of pathogenesis, genetics, and diagnostic criteria of mastocytosis, clear and reliable prognostic markers are still lacking, especially in order to predict systemic involvement. not only in diffuse but also in the commoner forms of the disease.
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Affiliation(s)
- Bartłomiej Wawrzycki
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland.
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19
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Current world literature. Curr Opin Pediatr 2012; 24:547-53. [PMID: 22790103 DOI: 10.1097/mop.0b013e3283566807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Mastocytoses are a group of rare diseases characterized, in most cases, by a benign proliferation and accumulation of mast cells in different tissues. In children, mastocytosis affects usually exclusively the skin and differs in many aspects from adult-onset mastocytosis. Except for diffuse cutaneous mastocytosis, which is an uncommon subtype of childhood-onset mastocytosis, involvement of the bone marrow or additional extracutaneous organs is rarely seen in children. The prognosis of childhood-onset mastocytosis is usually very good. Compared to adult patients who most commonly experience chronic-stable or slowly progressive disease, mastocytosis in children is mostly transient and self-limiting. In this review, we present and discuss the subtypes of childhood-onset mastocytosis, recent advances in the understanding of their pathogenesis as well as similarities and differences between adult- and childhood-onset mastocytosis.
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Affiliation(s)
- F Siebenhaar
- Interdisciplinary Mastocytosis Center Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin.
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21
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Deverrière G, Carré D, Nae I, Cailliez D, Boulloche J. [Bullous mastocytosis in infancy: a rare presentation]. Arch Pediatr 2012; 19:722-5. [PMID: 22664234 DOI: 10.1016/j.arcped.2012.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 02/18/2012] [Accepted: 04/24/2012] [Indexed: 12/30/2022]
Abstract
Mastocytosis is a rare condition related to an abnormal proliferation of mast cells and their accumulation in tissues. Cutaneous mastocytosis is the most common form and mainly affects newborns and infants. The symptoms are caused by the release of mediators contained in mast cells, including histamine. Mastocytosis may be associated with a mutation in the gene encoding the c-kit receptor. Clinically, there are different dermatological findings, which combine acute cutaneous, digestive, or even hemodynamic manifestations in varying degrees. The diagnosis is confirmed by the histological study of a skin sample. We report here the case of a 4-month-old infant suffering from diffuse cutaneous bullous mastocytosis, a very rare variety of mastocytosis. This infant had an erosive and bullous manifestation of dermatosis, initially confused with impetigo. The proliferation of bullous lesions led to her hospitalization. Codeine intake for pain was responsible for a large and extensive bullous reaction associated with anaphylactic shock. This context of bullous spread occurring after taking codeine led to the suspicion of bullous diffuse cutaneous mastocytosis, a diagnosis that was confirmed histologically. This observation demonstrates the difficulty of mastocytosis diagnosis, mostly due to its rarity, especially in its diffuse bullous forms. The rapid deterioration of this patient, after the codeine prescription, emphasizes the importance of the eviction of histamine-releaser compounds in the management of this disease.
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Affiliation(s)
- G Deverrière
- Service de pédiatrie, groupe hospitalier du Havre, 55 bis, rue Gustave-Flaubert, 76600 Le Havre, France.
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