A case of adult mastocytosis accompanied with anaphylaxis

In August 2007, a 43-year-old male had a fracture in his left arm. Surgical intervention which comprised the use of metal plates was necessary. In September 2007, during the convalescent period at home following the operation, after the subject had dinner, which included the ingestion of alcohol, he was performing rehabilitation exercises when he suddenly developed acute head itching, vomiting, and finally, loss of consciousness. He was rushed to the emergency room and treated with steroids and inotropic agents. The patch tests for the material contained in the metal plates, Titan-Vanadium-Aluminum alloy and Titan, were both positive. A sample of tissue, harvested from around the plates, showed the presence of inflammatory cells with eosinophilic cells, foreign bodies and macrophages engulfing them in the connective tissue. The subject presented with brown macules on the upper trunk and the neck which both turned red every time he ingested alcohol. He consulted our department in March 2009. The Darier sign was positive on the lesion. A biopsy sample showed infiltration of mast cells in the dermis. Toluidine-blue and tryptase stains were positive. Consequently, his condition was diagnosed as mastocytosis accompanied by anaphylaxis. Additionally, it was inferred that alcohol was the anaphylaxis-precipitating agent Furthermore, due to the pathology findings and the fact that the subject did not develop any trace of anaphylaxis once the plates were removed, it was considered that the metal allergy may have been related to the anaphylaxis.