DISCUSSIONS
A diagnosis of SM was proposed for our patient based on the clinical features and bone marrow biopsy.
The released cytokines by mast cell degranulation can cause acute symptoms of mastocytosis like anaphylactic shock and syncope, or chronic symptoms, such as skin lesions and abdominal discomfort.11,12 About one-third of patients have neuropsychological symptoms, which suggests the cerebral impact of mast cells. Stress is a major factor in symptom outbreaks and is frequently disregarded while treating mastocytosis.14 Emotional stress anticipated vasomotor collapse events in our patient, especially during ICU admissions. Moreover, research indicates that stress-induced mast cell activation has a role in neuroinflammatory diseases such as multiple sclerosis, asthma, and atopic dermatitis. 15Through corticotropin-releasing hormone (CRH), stress activates the hypothalamic-pituitary-adrenal axis, inducing neuroinflammation and disruption of the blood-brain barrier, which may lead to seizures. Histamine neurons in the hypothalamus, which control oxytocin, vasopressin, and ACTH,17 may have a role in mastocytosis by influencing the central nervous system. Specifically, H3 histamine receptors are essential for the blood-brain barrier to function, and their activation can affect neuroinflammatory responses by lowering the release of dopamine, serotonin, and norepinephrine.18 This suggests that stress-related mast cell degranulation might cause vascular instability and seizures because of the irritative effects of histamine on the brain. Thus, we recommend the patient avoid stressful triggers, alcohol, non-steroidal anti-inflammatory drugs, beta-blockers, and cholinergic antagonists.19
Considering the strong relationship between emotions and physical symptoms in mastocytosis, a holistic approach was proposed based on homeopathy. Based on the ”Law of Similars,” homeopathy stimulates the body’s natural healing processes by using extremely diluted compounds from plants, minerals, or animals. 20 Homeopathy is a safe and effective alternative treatment that helps enhance the body’s ability to restore balance, speeds healing and is also inexpensive.21, 22 In contrast to focusing just on symptoms, which may only provide temporary relief, this holistic approach treats the individual as a whole, considering both mental and physical symptoms.23 Moreover, according to homeopathy, each person’s health is ranked on a scale, with greater health and resistance to illness being associated with an effective defense system. Using suppressive techniques to treat acute symptoms might impair one’s health, putting the patient down on the scale and raising the chance of developing more serious conditions. 24