Medical neurobiological and psychobehavioral perspectives of mastocytosis: a case report

摘要

Medical data and stressful life events. Horizontal axis corresponds to the age of the patient (in years). Green triangles represent annual stress scores. Holmes and Rahe Social Readjustment Rating Scale was used to score each stressful life event (in “Life Change Units” LCU). Scores were calculated after the clinical interview of the patient. LCU applied to life events during 1 year were summed to assess the annual stress score. Red lines indicate the periods of cutaneous events recorded in the medical chart. Annual stress scores of life events were low (<50) during childhood. We did not have documentation about the medical status during this period. At the age of 22 years, two major stressful life events occurred: business readjustment (39 LCU) and divorce (65 LCU), totaling a global stress score of 104 LCU. At 23 years old, a second business readjustment (39 LCU) occurred with an abroad change in living conditions (25 LCU) (annual stress score = 39 + 25 = 64 LCU). Mastocytosis crisis (red lines) appeared at the age of 24 years as localized brown cutaneous lesions. It was scored with 53 LCU (according to Holmes and Rahe instructions, pathological events are considered to be stressful and scored with 53 LCU). At the age of 25 years, the patient moved to another country (Africa, 39 LCU) and married (50 LCU) (annual stress score = 89 LCU). The patient contracted subcutaneous filariasis at age 27 years (53 LCU) and developed a Quincke’s edema of unknown origin (53 LCU) at age 30 years. Until her 50th birthday, events such as the birth of two daughters and the adoption of a third daughter were reported, and were considered as mildly stressful on the Holmes and Rahe scale. No new somatic event occurred during this life period, and the patient did not consult a physician for mastocytosis. At the age of 51 years, she moved again within Africa for a job (39 LCU) and suffered from her father’s death (63 LCU) (annual stress score = 102 LCU). Subsequently, she developed brown cutaneous lesions related to mastocytosis, treated with corticoids. At the age of 53 years, while the patient and her husband were working in the same company, she realized that he was having an affair with a woman colleague (65 LCU). Then, cutaneous lesions were extended progressively and the patient developed mastocytosis symptoms again. From the age of 55 to 64 years, she suffered chronically from brown maculopapules (red lines), which could have been influenced by family-related events, such as one daughter’s marriage (39 LCU) and a patient’s divorce (65 LCU) (annual stress score = 104 LCU at 56 years old); the death of her mother (63 LCU), the departure of the last daughter (29 LCU), and retirement (45 LCU) (annual stress score = 74 LCU at 62 years old); and the death of the brother (63 LCU)