INTRODUCTIONMastocytosis represents a clonal, neoplastic proliferation of morphologically and immunophenotypically abnormal mast cells, organized in multifocal clusters, in one or more organ systems.1 It is considered a rare hematological condition, with a prevalence of 1 in 10.000 persons. 2 However, mastocytosis remains underdiagnosed, due to the heterogeneous clinical presentation.3 Based on the site of the clonal proliferation, mastocytosis can be divided into cutaneous mastocytosis and systemic mastocytosis (SM). Cutaneous mastocytosis is generally benign, primarily affects children within the first two years of life, and remits around adolescence. It usually manifests with skin lesions, gastrointestinal cramps, and anaphylaxis. 1,2 SM mainly affects adults. The clonal proliferation involves the bone marrow, the skin, and other organs and it has a chronic evolution, with a poor prognosis.4 Besides skin rashes and gastrointestinal symptoms, patients with SM may experience cardiovascular problems, like an irregular heartbeat; neuropsychiatric 5,6complications including anxiety or depression; osteoporosis due to mast cell infiltration into bones; anaphylaxis and hypotension.The pathophysiology of SM is represented primarily by mutations in the KIT gene, particularly the KITD816V variant, which leads to uncontrolled mast cell proliferation.1, 3, 7The diagnosis of SM usually requires a bone marrow biopsy. A positive diagnosis is based upon the 2016 WHO (World Health Organization) criteria (Table 1): one major and one minor criterion is required, or in the absence of the major criteria, three minor criteria need to be met.1, 2, 3, 7The treatment strategy of SM is highly reliant upon the subtype,3 mast cell leukemia having the worst prognosis out of all the subtypes, with a median survival of 2 months.8 In this regard, easier forms, benefit supportive treatment of mast cell mediator-related symptoms and osteoporosis. Mast cell mediator-related symptoms can be treated with antihistamines, H2-inhibitors, or aggressive treatment with epinephrine, corticosteroids, leukotriene receptor antagonists, or omalizumab in case of anaphylaxis. 9 Osteoporosis prevention and treatment can be done with calcium+D3 supplements, bisphosphonates, or alpha interferon. More advanced forms benefit from cytoreductive therapy, often with Midostaurin because it is currently considered the gold-standard treatment with a response rate of 60% and the best results in the aggressive SM subtype.7 Usually it is well tolerated, and it can also be used as a maintenance therapy after an allogeneic stem cell transplant. There are very few studies that have demonstrated the superiority of allogeneic stem cell transplants over KIT inhibitors. Therefore, this treatment is reserved for cases of SM with severe symptoms that are refractory to standard therapy.3

Introduction: Continuum theory states that suppression of efficient acute inflammation is one of the mechanisms responsible for the onset of chronic low-grade inflammation, and in the presence of chronic inflammation, an organism is not capable of an efficient acute inflammatory response to pathogenic stimuli. Materials and methods: We investigated medical records from a large clinical database to assess whether chronic and acute inflammation were mutually exclusive. To evaluate this question, we gathered data on age, current diagnosis, comorbidities and last high fever. Results: A total of 927 cases of chronic inflammatory diseases were investigated. A strong association was found between increasing age and a reduction in concurrent acute and chronic inflammation (chi-squared statistic 51.26; p< .00001). Twenty-one individual cases were examined for the pattern of acute and chronic inflammatory diseases. In most cases, there was a clear increase in acute inflammatory conditions as chronic diseases improved. Conclusions: This retrospective study showed a strong association of decreasing concurrent acute and chronic inflammatory states with increasing age, and a possible mutual exclusivity of efficient acute and chronic inflammation was indicated. Since ageing is a low-grade chronic inflammatory process, it is possible that chronic inflammation precludes efficient acute inflammation, which indicates that there is a need to reconsider the manner of handling of acute inflammation in the population.

Binswanger's disease is a type of vascular leukoencephalopathy that can lead to cognitive impairment and neurological deficits and is sometimes difficult to diagnose. We present a case of Binswanger's disease with an interesting differential diagnosis based on clinical aspects, laboratory findings and imaging studies.