A young woman who had repeated episodes of altered consciousness following insect stings was not diagnosed with systemic mastocytosis (SM) until much later, according to a case report published in The Journal of Allergy and Clinical Immunology: In Practice.
This case report represented multiple missed diagnostic opportunities, the report’s authors said. “Implicit gender bias” may partially explain why the patient’s most recent insect sting episode was dismissed as merely the symptom of anxiety, as if her pain were exaggerated, the study added.
What is SM?
Systemic mastocytosis (SM) is a rare hematological disease characterized by mast cells that are overactive and accumulate in different parts of the body such as the bone marrow, liver, spleen, gastrointestinal tract and lymph nodes.
“The patient’s symptoms were not appropriately evaluated twice despite the alarming nature of her sting-triggered symptoms,” study authors said. “Even in the absence of [hymenoptera venom allergy], patients presenting with recurrent episodes of possible idiopathic anaphylaxis, or severe features such as syncope, may provide clues to an underlying clonal mast cell disorder (MCD).”
Read more about SM testing and diagnosis
The 27-year-old woman reported altered or loss of consciousness following insect stings. Her first experience occurred at 20 years of age, during which she lost consciousness after being stung by a flying insect. At age 24, she again experienced loss of consciousness after being stung by ants. In both cases, she received supportive care but was not investigated for possible underlying allergies.
Most recently, the patient stepped barefoot on a fire ant mound and sustained four to five stings on each foot. Within 15 minutes, she experienced pruritus (itching) and was both flustered and lightheaded. She was admitted to the emergency department and was given fluid rehydration. She was told that her symptoms were likely caused by anxiety from the insect stings.
The patient’s primary care physician suspected that she had venom hypersensitivity and she was referred to an allergy clinician. She was thoroughly investigated, and the patient was confirmed to have hymenoptera venom allergy (HVA). She was further diagnosed with indolent SM and received appropriate treatment following her new diagnosis.
The authors highlighted the importance of increasing awareness about mast cell diseases among frontline health workers. A timely referral to an allergist and the subsequent initiation of relevant investigations can optimize health care delivery and prevent unnecessarily prolonged suffering, the authors said.
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