Urticaria pigmentosa both with and without systemic involvement has been well reviewed.1,2 Recently Davis et al.3 reported the case of an adult with cutaneous but no demonstrable systemic lesions of urticaria pigmentosa, who had flushing of the face, neck, and upper thorax. Analysis of the skin containing mast-cell infiltrates showed large amounts of histamine. We should like to report another interesting patient with urticaria pigmentosa and flushing, who also had systemic signs of mast-cell disease and otosclerosis. A 29-year-old white married mother of two children was hospitalized at the Yale-New Haven Medical Center from Dec. 13, 1955, to Dec. 17, 1955, for evaluation of possible metabolic disease of the bone. During the preceding summer, the patient had fallen on a waxed floor and subsequently experienced low back pain. X-rays of the pelvic bones showed a granular appearance due to disseminated minute areas of increased density separated by cystic-appearing