Multimodal therapy for vertebral involvement of systemic mastocytosis.
METHODS
Case report and clinical discussion.


OBJECTIVE
To describe a rare case of vertebral involvement of systemic mastocytosis and its multimodal therapy.


BACKGROUND
Vertebral fractures in young men are rare events. A thorough diagnostic work-up that unravels the underlying cause of osteoporosis and appropriate therapy are crucial to prevent further fractures.


METHODS
A 36-year-old man was evaluated for severe back pain and was found to suffer from progressive osteoporosis and multiple vertebral fractures. Bone biopsy analysis revealed tryptase-positive mast cells that were positive for c-KIT, thus confirming the diagnosis of systemic mastocytosis.


RESULTS
In addition to zoledronic acid (4 mg per month) and prednisolone (50 mg per day) treatment, the patient underwent kyphoplasty. The procedure was associated with arterial hypotension which was most likely because of pressure-induced mast cell degranulation. Follow-up visits demonstrated stable bone mineral density and tolerable back pain while on zoledronic acid.


CONCLUSIONS
Systemic mastocytosis is a rare cause of vertebral fractures in young men. Because of the potential risk of pressure-induced release of the allergy mediator histamine, kyphoplasty for vertebral involvement of systemic mastocytosis should be conducted with appropriate precautions.
Krüger
Antonio
A
Department of Trauma Surgery, Philipps-University, Marburg, Germany.
Hamann
Christine
C
Brendel
Cornelia
C
Ramaswamy
Annette
A
Schnabel
Michael
M
Neubauer
Andreas
A
Hofbauer
Lorenz C
LC
D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006632:Histamine / Q000378:metabolism; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D008407:Mast Cells / Q000378:metabolism / Q000473:pathology; D034721:Mastocytosis, Systemic / Q000150:complications*; D010024:Osteoporosis / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011239:Prednisolone / Q000627:therapeutic use; D011312:Pressure / Q000009:adverse effects; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis / Q000378:metabolism; D016103:Spinal Fractures / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D013131:Spine / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty; D000077211:Zoledronic Acid
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D007093:Imidazoles; D000077211:Zoledronic Acid; D006632:Histamine; D011239:Prednisolone; D019009:Proto-Oncogene Proteins c-kit