Almost half of our patient were hypoxemic on admission, and may have suffered of additional phases of hypoxia during hospitalization, so acute hypoxic cardiomyopathy, or a combination of acute hypoxia with pre-existing pathology, along with the presence of pro-apoptotic chemokines (e.g. TNFα, from systemic circulation or locally released by infected endothelial cells) may easily lead per se to necrosis and apoptosis, as supported by the significant correlation found between the severity of pneumonia and the amount of CM death. The gene discussed is TNF; the disease is cutaneous mastocytosis.