Osteoporosi maschile e anafilassi da imenotteri

AUTORI

ABSTRACT

Male osteoporosis and hymenoptera venom anaphylaxis

Mastocytosis is one of the rare causes of unexplained osteoporosis, above all in males. On the other hand, a strict association between severe systemic reactions after hymenoptera sting and mastocytosis was recently demonstrated. Here we report a case of unexplained severe osteoporosis with multiple vertebral fractures in a 48 years old male, which also suffered an anaphylactic reaction after hymenoptera sting. Among laboratory tests performed to clarify the cause of osteoporosis, serum tryptase concentrations were determined. The value of tryptase was 43.6 μg/L, four times higher than the upper reference limit. Skin did not show abnormalities; bone marrow vertebral biopsy was not valuable, but bone marrow aspirate from iliac crest demonstrated the presence of atypical mast cells expressing CD25; D816V mutation of KIT gene was also identified. These findings, in association with an increase of serum tryptase concentrations, fulfil all minor criteria requested for the diagnosis of systemic mastocytosis. Osteoporosis treatment with zolendronate and vitamin D supplementation was started, but later, for the persistence of bone pain, therapy with -interferon was added. This case confirms that an unexplained osteoporosis, especially if associated with hymenoptera sting systemic reaction, requires exclusion of a systemic mastocytosis.

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