A Shocking Case of Shock

Leon et al discuss the case study of a 74-year-old man with systemic mastocytosis (SM) with associated chronic myelomonocytic leukemia (CML). The patient presented to the hospital with hypotension, nausea, and vomiting. His SM and CMML were diagnosed several months before admission by bone marrow biopsy, which demonstrated hypercellular marrow with sheets of mast cells constituting 70% of bone marrow tells, dysplastic myeloid and megakaryocytic lineages, increased eosinophils and monocytes, and no excess blasts. The patient was taking midostaurin seven days before admission to treatl his SM but noted difficulty tolerating the medication, with four days of progressively worsening nausea, vomiting, diarrhea, abdominal pain, and hematemesis. Given these symptoms, midostaurin was held on admission.