https://scholarlycommons.hcahealthcare.com/cgi/viewcontent.cgi?article=1032&context=northtexas2024
O Olufemi Osikoya, MD and Gregory Brennan, MD (Department of Internal Medicine, Medical City Arlington, Arlington, TX; 2GI Alliance, Mansfield, TX)
Introduction
Mast cells (MCs) have many functions including regulation of GI epithelial homeostasis, cross talk of the brain gut axis, host immune defenses, and inflammatory pathways. MCs are found in all layers of the GI tract and have been implicated in various gastrointestinal diseases. Although previously described in the literature, mast cell colitis is not considered a distinct clinical entity. This poses a challenge to the gastroenterologist who encounters such pathologic findings
Case presentation
This is a case of a 76-year-old asymptomatic woman who was referred to the GI clinic for evaluation of a new diagnosis of colitis. Her previous colonoscopy performed by colorectal surgeon noted subtle mucosal changes in the right colon with patchy granularity and mild edema. She was recommended to undergo a repeat colonoscopy in one year and monitor for any symptoms. Repeat colonoscopy revealed granularity and patchy erythema in the entire colon with rectal sparing. Biopsies revealed colonic mucosa with atypical CD117 + mast cell infiltrates with a background increase in eosinophils. At that time, the patient was having occasional abdominal bloating. Denied flushing, pruritus, angioedema, nasal congestion, rhinorrhea, conjunctival injection, hives, rash, wheezing, or cough. Labs were normal including CBC with differential, celiac serology, CRP, and tryptase. Stool PCR panel was positive for Yersinia enterocolitica. After treatment with antihistamines and ciprofloxacin, symptoms resolved.
Conclusion
Mast cells have been implicated in various gastrointestinal diseases including food allergies, irritable bowel syndrome, microscopic colitis, and even inflammatory bowel disease. MC activation and degranulation may lead to abdominal pain, vomiting, diarrhea, heartburn, and peptic ulcer disease via histamine pathways. However, the clinical significance of finding MCs on colonic specimens is unclear. The finding of mast cells on colon biopsies warrants further investigation because of the potential implications of systemic diseases such as systemic macrocytosis. Referral to an allergist/immunologist is warranted as well. As demonstrated in our case, ruling out infection is important given the role MCs play in the immune response. We suspect that this indolent Yersinia infection was the driver of MC infiltration.
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