[Bone evaluation in ten adults with cutaneous mastocytosis]. / Evaluation de l'état osseux chez dix adultes atteints de mastocytose cutanée.

BACKGROUND: To systematically evaluate the bone status, searching for osteoporosis in patients with cutaneous mastocytosis. PATIENTS AND METHODS: In a prospective study from March 1997 to June 2000, we included all new patients examined for cutaneous signs of mastocytosis. Past history, physical examination, skin biopsy, laboratory tests, bone densitometry, cytology and histopathology of bone marrow and other complementary investigations were performed in all these patients. RESULTS: Ten patients were included. Two patients had osteoporosis. Five others had osteopenia. Four patients had bone marrow involvement due to mastocytosis. One of these four patients had myelodysplasia. DISCUSSION: This study suggests better investigation of bone density and bone marrow in patients who have cutaneous mastocytosis. Systematic histopathology of bone marrow and osteodensitometry help to detect patients with systemic involvement. Bone densitometry is particularly effective for early detection of patients at risk for fracture and is of practical interest since patients with osteoporosis can now be treated with Pamidronate.

[Clinical manifestations of the mouth revealing Vitamin B12 deficiency before the onset of anemia]. / Signes buccaux révélateurs d'une carence en vitamine B12 avant l'apparition d'une anémie.

INTRODUCTION: The association of manifestations in the mouth and Vitamin B12 deficiency is already known. The signs are not specific to Vitamin B12 deficiency, however they may reveal the deficiency and this is often ignored and leads to delays in diagnosis. We report two cases of Vitamin B12 deficiency revealed by stomatodynia, glossitis and erosions in the mouth. OBSERVATIONS: Two women aged 51 and 76 years consulted, one for atrophic glossitis and the other for stomatodynia that had progressed over the past few months. No other symptoms were present. The biological examinations revealed isolated macrocytosis without anemia. Vitamin B12 could not be measured in the serum. The symptoms regressed in less than one month following replacement therapy. DISCUSSION: As with our two patients, the majority of cases of Vitamin B12 deficiency reported in the literature were only discovered several months or years after their onset, or were treated for other causes. Vitamin B12 deficiency leads to severe neuropathies. The neurological damage is reversible when replacement therapy is initiated early. Since the oral signs appear before the modification in the systemic markers of deficiency, it is crucial that these signs be recognized and diagnosed before the occurrence of severe after effects.