title: Urticaria as initial finding of a patient with carcinoid tumor.
abstract: BACKGROUND
  Typical carcinoid syndrome is characterized by flushing, abdominal pain and diarrhea and occurs in <10 % of carcinoid tumor patients. Very rarely, initial signs include skin manifestations. Our purpose is to highlight cutaneous manifestations in the diagnosis and assessment of a patient with atypical manifestation of type I gastric carcinoid tumor.
  
  
  METHODS
  A 50-year-old woman presented with anemia, chronic urticaria and angioedema. Urticaria was triggered principally by seafood and appeared in the first hour after. Urticaria Activity Score 7 was 24, and quality of life (CU-Q2oL) was 3.61. P. Laboratory findings showed anemia, diminished iron, ferritin, and vitamin B12, with increased gastrin and anti-parietal cell antibody levels. 15 gastric carcinoids 5 mm in diameter were observed in the greater curvature of the stomach during gastric endoscopy and confirmed by biopsy, suggesting that this patient had type I gastric carcinoids. Four additional tumors were found in the small intestine upon examination via video capsule. Endoscopic argon plasma therapy was performed. The patient experienced definitive improvement in quality of life and urticaria activity score.
  
  
  CONCLUSIONS
  This patient, whose principal symptoms were anemia, urticaria and angioedema, was found to have atypical carcinoid syndrome, with tumors located in the stomach. Allergists, immunologists, internists and primary care physicians should consider the possibility of neuroendocrine malignancies, specifically type I carcinoid tumors, when evaluating patients with urticaria, and consider screening patients with chronic urticaria for elevated anti-parietal cell antibody levels.
authors.affiliation: Universidad de Especialidades Espíritu Santo, School of Medicine, Samborondón, Ecuador ; Respiralab Research Group, Clínica Kennedy, Guayaquil, Ecuador.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cherrez Ojeda
authors.affiliation: Universidad de Especialidades Espíritu Santo, School of Medicine, Samborondón, Ecuador ; Respiralab Research Group, Clínica Kennedy, Guayaquil, Ecuador.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Calderon
authors.affiliation: Universidad de Especialidades Espíritu Santo, School of Medicine, Samborondón, Ecuador.
authors.forename: Karin
authors.initials: K
authors.lastname: Plaza
authors.affiliation: Universidad de Especialidades Espíritu Santo, School of Medicine, Samborondón, Ecuador.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Vanegas
authors.affiliation: Respiralab Research Group, Clínica Kennedy, Guayaquil, Ecuador ; University of Heidelberg, School of Medicine, Heidelberg, Germany.
authors.forename: Annia
authors.initials: A
authors.lastname: Cherrez
authors.affiliation: Universidad de Especialidades Espíritu Santo, School of Medicine, Samborondón, Ecuador.
authors.forename: José
authors.initials: J
authors.lastname: Cano
keywords: Antibodies; Carcinoid tumors; Enterochromaffin cells; Kinin; Quality of life; Serotonin; Urticaria