title: Flushing and increase of serum tryptase after mechanical irritation of a solitary mastocytoma.
abstract: Solitary mastocytomas are infiltrates of mast cells in the upper corium, appearing at any side of the body as brownish-reddish plaques in the first months of life. Their course is benign with a spontaneous regression in most cases. A 5-month-old boy presented a 5 x 3 cm sized brownish-yellow plaque on the back of his right hand. His parents reported repeated episodes of swelling and blistering of the skin lesion as well as recurrent systemic flush-reactions. General laboratory parameters were without pathological findings including a normal serum tryptase (5.5 microg/L). A few minutes after rubbing, the lesion became urticarially swollen and the infant developed a general flush reaction accompanied by a bilateral miosis and asthma-like symptoms which disappeared completely after oral administration of 7 drops of dimentinden. Assessment of the serum tryptase two hours after the provocation revealed a more than 5-fold increase (29.3 microg/L) compared to the basic value. We conclude that uncontrolled stroking of mastocytomas should be avoided in patients with a systemic reaction in their history, since this case demonstrates that despite its limited size, mechanical irritation of a solitary mastocytoma may induce strong systemic symptoms as witnessed by transient increase of the serum tryptase, which to our knowledge has not been described in the literature before.
authors.affiliation: Department of Dermatology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bussmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Hagemann
authors.forename: Julia
authors.initials: J
authors.lastname: Hanfland
authors.forename: Gerhard
authors.initials: G
authors.lastname: Haidl
authors.forename: Thomas
authors.initials: T
authors.lastname: Bieber
authors.forename: Natalija
authors.initials: N
authors.lastname: Novak
mesh_terms: D005483:Flushing / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D034801:Mastocytoma / Q000097:blood* / Q000150:complications*; D053802:Tryptases / Q000097:blood*
chemical_list: D053802:Tryptases