Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
New England Journal of Medicine
Sep 24, 2025
2 min read
Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
New England Journal of Medicine
September 24, 2025
2 min read
Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
Luís Neves da Silva, MD and Ana Margarida Monteiro, MD
New England Journal of Medicine
September 24, 2025
2 min read
Topics
In this Image in Clinical Medicine from the New England Journal of Medicine, a maculopapular rash and osteosclerotic thoracic vertebral bodies on imaging are seen in an adult with diarrhea and weight loss.
The authors describe an adult man who presented with a several-month history of a maculopapular rash on the trunk, arms, and legs, along with weight loss. After obtaining labs, abdominal imaging, and a bone marrow biopsy, his clinicians diagnose systemic mastocytosis (SM), a condition characterized by mast-cell infiltration of organs — skin and bone, in this case.
Clinicians should know that SM is rare and can present in an indolent fashion where skin findings predominate, usually in the form of an itchy and flushing maculopapular rash (urticaria pigmentosa). Treatment is mainly symptomatic. In this case, the patient presents with the more advanced form of SM, in which skin symptoms are less problematic and mast cells have infiltrated…
Comment
The authors describe an adult man who presented with a several-month history of a maculopapular rash on the trunk, arms, and legs, along with weight loss. After obtaining labs, abdominal imaging, and a bone marrow biopsy, his clinicians diagnose systemic mastocytosis (SM), a condition characterized by mast-cell infiltration of organs — skin and bone, in this case.
Clinicians should know that SM is rare and can present in an indolent fashion where skin findings predominate, usually in the form of an itchy and flushing maculopapular rash (urticaria pigmentosa). Treatment is mainly symptomatic. In this case, the patient presents with the more advanced form of SM, in which skin symptoms are less problematic and mast cells have infiltrated…