DÄ internationalArchive24/201812 Vertebral-Body Fractures and Simultaneous Skin Changes

Clinical Snapshot

12 Vertebral-Body Fractures and Simultaneous Skin Changes

Dtsch Arztebl Int 2018; 115(24): 418; DOI: 10.3238/arztebl.2018.0418

Gehlen, M; Lazarescu, A D; Hinz, C

a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty. b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.
a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty. b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.
Figure
a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty.
b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.

A 57-year-old woman had developed a pruritic, brownish-red, maculopapular rash on her legs at age 40 (positive Darier’s sign) that persisted thereafter, with variable intensity. A physician had suspected urticaria pigmentosa at the time, but no treatment was recommended. At age 51, she had sustained a femoral neck fracture and four vertebral body fractures, without any antecedent trauma and without any known risk factors. Osteoporosis was diagnosed and treated with strontium ranelate. At age 57, the patient had fractures of all vertebral bodies from T6 to L5 and a threefold elevation of the serum tryptase level. Laboratory findings, skin and bone marrow biopsy fulfilled the criteria for systemic mastocytosis (major: multifocal mast-cell infiltrates, minor: fusiform mast cells, expression of CD25 and CD2, KIT mutation, serum tryptase level). The patient was initially treated with zoledronate 4 mg every six months. At one year, no further compression fractures were seen.

Systemic mastocytosis can cause cytokine-mediated stimulation of osteoclasts, leading to osteoporosis. Osteoporosis of unclear origin (in a young patient without any known risk factors) should be thoroughly evaluated, and systemic mastocytosis should be considered in the differential diagnosis.

Dr. med. Martin Gehlen, Dr. Ana Doina Lazarescu, Christian Hinz,
Klinik Der Fürstenhof Fachklinik für Rheumatologie, Orthopädie und Osteologie, Klinisch osteologisches Schwerpunktzentrum und osteologisches Forschungszentrum DVO, Bad Pyrmont, gehlen@staatsbad-pyrmont.de

Conflict of interest statement:
The authors state that they have no conflict of interest.

Translated from the original German by Ethan Taub, MD

Cite this as: Gehlen M, Lazarescu AD, Hinz C: 12 vertebral-body fractures and simultaneous skin changes. Dtsch Arztebl Int 2018; 115: 418. DOI: 10.3238/arztebl.2018.0418

a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty. b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.
a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty. b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.
Figure
a) Lateral lumbar spine x-ray: there are osteoporotic fractures of all vertebral bodies from T10 to L5 (superior endplate impression fractures, concave fractures of both endplates, wedge fractures). Bone cement has been introduced into T11, T12, and L1 by vertebroplasty.
b) Red-brownish maculopapular efflorescences along the thighs. Skin changes were augmented by rubbing (positive Darier’s sign). These findings fit to urticaria pigmentosa. The scars were related to a fracture of the femoral neck 6 years earlier.