A MAST KNOWN CAUSE OF SHOCK

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: The main types of shock include cardiogenic, hypovolemic, distributive, and neurogenic shock. Management requires identifying correcting the underlying cause, supporting end-organ perfusion with fluid resuscitation vasoactive medications. Here we present a rare cause distributive CASE PRESENTATION: A 65-year-old man presented 2-month history progressive weakness. Laboratory studies reviewed new thrombocytopenia to 25 x10(9)/L acute renal failure creatinine 3.24 mg/dL. His bone marrow biopsy was concerning for mast cell leukemia, he started on treatment 1 gram methylprednisolone. About hour after receiving this infusion, developed chest pain, tachycardia tachypnea. He urgently transferred ICU. In ICU, his condition progressed into ventricular fibrillation requiring CPR, defibrillation, intubation. in refractory circulatory high doses norepinephrine, epinephrine, vasopressin, stress dose steroids. Given empirical activation syndrome started. received scheduled diphenhydramine, famotidine, montelukast cromolyn. Patient quickly weaned off medications next 24 hours. Tryptase obtained at time hypotensive event markedly elevated greater than 2000 ng/mL. had worsening replacement therapy, given diagnosis hematological malignancy limited options mortality, focus care transitioned concentrate solely comfort. DISCUSSION: Mast disorders cutaneous systemic mastocytosis, allergic diseases, idiopathic disorders. Acute leukemia is form mastocytosis characterized by least 20% immature cells marrow. Sudden leads degranulation release pre-formed mediators including histamine. It also stimulates de novo synthesis other cytokines chemokines. Typical symptoms flushing, lightheadedness abdominal cramping, but can progress syncope shock, as seen our patient. Treatment includes identification avoidance triggers, supportive antihistamines (both H1 H2 blockers) cromolyn (mast stabilizer). CONCLUSIONS: essential critical clinicians recognize potential especially risk patients mastocytosis. Prompt facilitate resolution REFERENCE #1: Akin C, Valent P, Metcalfe DD. syndrome: Proposed diagnostic criteria. J Allergy Clin Immunol. 2010;126(6):1099-104.e4. doi:10.1016/j.jaci.2010.08.035 #2: Molderings GJ, Haenisch B, Brettner S, et al. Pharmacological disease. Naunyn Schmiedebergs Arch Pharmacol. 2016;389(7):671-694. doi:10.1007/s00210-016-1247-1 DISCLOSURES: No relevant relationships Alice Gallo De Moraes, source=Web Response Zhenmei Zhang,