Abstract ID: 26-586
Periorbital Dermatitis and Oedema in Suspected Mast Cell Activation Syndrome: A Case Report
Author: Nishita Patel Base Hospital / Institution: Bexhill Hospital/ East Sussex NHS Trust
Presentation Type: ePoster Presentation
Purpose
Mast Cell Activation Syndrome (MCAS) is characterised by mast cell degranulation causing recurrent systemic symptoms. Due to its loose connective tissue and rich vascular supply, the periorbital region is particularly susceptible to vasoactive and proinflammatory mediators, resulting in periorbital dermatitis and angioedema. Literature describing orbital manifestations of MCAS remains limited, likely due to under recognition and diagnostic uncertainty.
Methods
We present a case report of a patient with ocular symptoms that improved following histamine-directed treatment for suspected MCAS.
Results
A 47-year-old female presented with recurrent right periorbital erythema, swelling, stinging and scaling, also affecting the left eye, nasal bridge and cheeks. Flares were associated with conjunctival redness and grittiness and persisted despite cessation of possible triggers including dapagliflozin and perindopril. Examination demonstrated no lid retraction, proptosis or ophthalmoplegia. Lupus and thyroid autoantibodies were negative. Dermatology review suggested suspected MCAS given recurrent anaphylaxis with multisystem involvement including flushing, angioedema, gastrointestinal upset, nasal congestion and conjunctival irritation. Following a low histamine diet and H1/H2 antihistamines, the patient reported significant improvement in periocular and systemic symptoms.
Conclusion
MCAS should be considered in patients presenting with persistent periorbital dermatitis or oedema alongside multisystem symptoms. Elevation of mast cell mediators such as tryptase and response to drugs that target mast cell mediators or suppress mast cell activation support a diagnosis of MCAS. This case highlights the importance of recognising possible histamine-mediated mechanisms in otherwise unexplained periocular inflammation.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Elizabeth | Louise Saldana | University of Buckinghamshire Medical School |
| Matthew | Seager | Bexhill Hospital/ East Sussex NHS Trust |