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