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Unexpected vertebral fractures
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Steve (not his real name) presented to the clinic with a recent history of vertebral fractures. He is 68 inches tall, weighs in at 170 lb., with a BMI of 26 and a pain scale 0/10. He is about 6 inches shorter than his father, but taller than his mother.
Neither Steve nor his parents can think of an event that might have led to the fractures – they seemed to occur spontaneously and, not surprisingly, malignancy was the expected diagnosis.
Steve never complained of back pain but on examination he had asymptomatic curvature of the spine with only one finger breadth between the ribs and the pelvis. He did not have much trouble bending.
Almost on a whim I “scratched” his back and was very surprised to see a “weal and flare” response – very suggestive of urticaria pigmentosa although systemic mastocytosis has not been ruled out.
X-rays confirmed mild compression fracture at L3 and a severe compression fracture at T12.
He was immediately referred to an orthopedic surgeon who deferred any surgery until appropriate evaluation is completed by a dermatologist and a possibly also a rheumatologist. His reasoning made a lot of sense and the family readily accepted his advice.
To my recollection I have only cared for one other patient with spontaneous vertebral fractures and urticaria pigmentosa and review of the literature did not offer much information on this.
As always, I would appreciate hearing from anyone with more knowledge of this clinical finding.