A 25-year-old woman with no relevant past medical history.
At 23 years of age, the patient presented with sunken erythematous skin lesions on the lower limbs and a positive Darier's sign, associated with lipothymia trunking and exposure to heat.
She denied urticarial reactions and anaphylaxis.
Skin biopsy confirmed urticaria pigmentosa.
A study was complemented with serum tryptase that resulted in 40 ng/ml (normal value (nv) ≤ 11.4 ng/ml).
Bone marrow biopsy was compatible with SM.
A genetic study was carried out to find a mutation of cKIT D816V (+).
Indolent SD was diagnosed and treatment with sodium chromoglycate was started.
Bone involvement without history of bone pain, lithiasis or fractures was sought.
He consumed 2 milk units per day.
Menarche at age 12 and had regular menstrual cycles.
She was nulligravida and did not use hormonal contraceptives.
Bone densitometry (DXA) showed DMO in L2-L4 0.880 g/cm2 (Z score -2.3) and femoral neck 0.719 g/cm2 (Z score -2.1).
Low bone mass secondary to SM was diagnosed.
Calcium and vitamin D intake was optimized and Ibandronate 150 mg/month oral was indicated.
This management was maintained for two years, after which it was studied for the first time in our center.
The study was updated: normal biochemical profile, creatinine 0.78 mg/dL, normal thyroid function, 25OHD 32 ng/ml (vn: ≥ 20), serum Carboxytelopeptide 0.0247 ng/ml (CTx 0.173).
Control DXA showed an increase of 7.2% in L2-L4 and 8.3% in hips.
The patient reported desire for fertility so it was decided to discontinue Ibandronate and follow-up with DXA and bone resorption markers (CTx).
