Patient Medical History
Georgia is a 32 year old woman who has been suffering from recurrent (sometimes severe) headaches, and periods of fatigue since late childhood (~10-11 years of age). In her early twenties (21 years of age) she was diagnosed with gastroesophageal reflux disease (GERD) and began to experience periods of unexplained abdominal pain.
Georgia’s symptoms have waxed and waned over times, sometimes she feels fine but other times (since ~10-11 years of age) the headaches, fatigue and abdominal pain (since ~21 years of age) seem overwhelming. Lately the fatigue and abdominal pains have been particularly bad.
Georgia is afraid to eat because she does not know when the abdominal pain will strike or what is causing it. She has begun to lose weight but her food restriction has not addressed the pain. Regardless of whether she has eaten a large or small meal, and regardless of ingredients the pain can occur.
Georgia’s doctor performed several tests and noticed symptoms of inflammation in some areas of the intestine, after ruling out other conditions her doctor has suggested Georgia may have Inflammatory Bowel Disease (IBD). However, IBD would not explain why Georgia sometimes experiences upper abdominal pain or why the location of the pain seems to move around different areas of the abdomen.
Georgia feels tired all of the time; the amount of sleep she gets does not seem to lessen the fatigue. She finds mornings especially difficult but fatigue is present throughout the day. She finds it difficult to concentrate and her performance at work has begun to suffer. She sometimes feels too tired to climb the stairs to her second floor apartment.Her doctor sent her to a sleep clinic but an overnight sleep observation study did not find anything abnormal.
While Georgia is most concerned with the abdominal pain and fatigue she has other symptoms as well.
Georgia's Symptoms
Georgia’s doctor has consulted some colleagues who recommended a full blood work up and tests to measure the levels of some key immune response molecules.
Georgia's Test Results
Q1 How might an immune response contribute to abdominal pain?
Q2 What common immune response involves all of the markers elevated in Georgia’s tests: tryptase, histamine and prostaglandin D2?
After reviewing her tests Georgia’s doctor concludes she has Mast Cell Activation Syndrome (MCAS), a disease characterized by chronic multi-system inflammation. Her doctor rules out mastocytocis (accumulation of mast cells).
Basically Georgia’s mast cell responses are too strong which could be because she has too many mast cells, her mast cells are hyperactive or both. Since her doctor has ruled out mastocytosis there are not an abnormal number of mast cells.
We initially looked at white blood cells commonly found in circulation and therefore when it came to granulocytes focused on basophils, eosinophils and neutrophils. Mast cells are also granulocytes but are found in tissues.
Q3 What do granulocytes all have in common both in structure and in immune response roles?
Q4 Describe the link between aberrant (too strong) mast cell responses and chronic multi-system inflammation.
Answer:
Q-1)a):
Q-1b):
Q-1C):
Q-1D)
Q-1e):
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Patient Medical History Georgia is a 32 year old woman who has been suffering from recurrent...
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