Mucinosis pretibial como manifestación de dermatitis de estasis
Pretibial mucinosis as a manifestation of stasis dermatitis.
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=> "affa" ] ] ] 5 => array:3 [ "nombre" => "María Teresa" "apellidos" => "Abalde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "nombre" => "Carlos" "apellidos" => "Feal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 7 => array:3 [ "nombre" => "Manuel J" "apellidos" => "Cruces" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología. Complejo Hospitalario de Pontevedra. Pontevedra. España." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pretibial mucinosis as a manifestation of stasis dermatitis." ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "103v94n07-13051719fig01.jpg" "Alto" => 231 "Ancho" => 351 "Tamanyo" => 13217 ] ] "descripcion" => array:1 [ "es" => "--Placa pretibial izquierda." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"> INTRODUCCION</p><p class="elsevierStylePara">El mixedema pretibial se describe habitualmente como una manifestación de la enfermedad de Graves. Sin embargo, se han descrito casos de mucinosis pretibial no asociados a enfermedades del tiroides, que probablemente sean ocasionados por alteraciones del retorno venoso o linfático. Existen signos histológicos que permiten la diferenciación de estas dos etiologías del depósito de mucina pretibial.</p><p class="elsevierStylePara">DESCRIPCION DEL CASO</p><p class="elsevierStylePara">Un varón de 86 años consultó por la presencia de una placa pretibial izquierda asintomática, que en el último año había ido creciendo y casi circundado la pierna. Presentaba antecedentes de diabetes mellitus tipo II controlada con dieta, insuficiencia cardíaca congestiva, miocardiopatía hipertensiva, e insuficiencia venosa de más de 10 años de evolución. En la exploración física se apreciaba una placa en el tercio distal de la pierna izquierda, de 7 cm de ancho máximo en la zona anterior y que formaba una banda más estrecha en la parte posterior de la pierna, compuesta por pequeñas pápulas confluentes, de color céreo pardusco, con áreas purpúricas (fig. 1). Se observaron, además, un intenso edema con fóvea en ambas piernas y varicosidades bilaterales. En las exploraciones complementarias destacaban: hormona tiroestimulante (TSH), 1,81 μU/ml (normal, 0,35-4,94), ausencia de anticuerpos antitiroideos (antiperoxidasa, antitiroglobulina y antirreceptor de TSH), un proteinograma e inmunoelectroforesis en sangre y orina normales, y una serología de virus de la inmunodeficiencia humana (VIH) negativa.</p><p class="elsevierStylePara"><img src="103v94n07-13051719fig01.jpg"></img></p><p class="elsevierStylePara">Fig. 1.--Placa pretibial izquierda.</p><p class="elsevierStylePara">El estudio histológico de las lesiones mostró la presencia de un cierto grado de atrofia epidérmica y cambios de estasis crónico con una proliferación de ovillos capilares, hemorragia y hemosiderina. Destacaba la presencia en la dermis papilar de áreas mixedematosas, contiguas a la epidermis, con fibroblastos estrellados (mucoblastos) y con la presencia de un material granular y filamentoso de tipo mucina dérmica (azul alciano [pH 2,5] positivo y ácido peryódico de Schiff [PAS] negativo) (fig. 2). El depósito de mucina no afectaba a la dermis reticular.</p><p class="elsevierStylePara"><img src="103v94n07-13051719fig02.jpg"></img></p><p class="elsevierStylePara">Fig. 2.--Depósito de mucina en la dermis papilar, sin zona grenz, y con angioplasia y hemosiderina (hematoxilina-eosina).</p><p class="elsevierStylePara"> DISCUSION</p><p class="elsevierStylePara">El mixedema pretibial es una mucinosis cutánea primaria, que suele considerarse una manifestación de la enfermedad de Graves<span class="elsevierStyleSup">1</span>. Ocasionalmente, se han descrito casos sin enfermedad tiroidea, y en pacientes eutiroideos con signos de alteración inmunológica antitiroidea<span class="elsevierStyleSup">2-4</span>. En 1993, Somach et al<span class="elsevierStyleSup">5</span> publicaron una serie de casos de depósito de mucina pretibial, en la que distinguían los casos en los que existía una enfermedad de Graves de aquellos no asociados con ella. Los no asociados con una enfermedad de Graves tenían como denominador común la presencia de enfermedades que ocasionan estasis crónica. Además, definieron unos criterios histológicos que sirven para diferenciar el mixedema pretibial (asociado a enfermedad de Graves) de la mucinosis pretibial por estasis crónica<span class="elsevierStyleSup">5</span>. Así, sugieren la asociación con enfermedad del retorno venoso o linfático; la presencia de mucina en la dermis papilar hasta la unión dermoepidérmica y sin afectar a la dermis reticular, la existencia de angioplasia y el depósito de hemosiderina. En el mixedema pretibial de la enfermedad de Graves existe una zona de colágeno respetado bajo la unión dermoepidérmica, la mucina llega a la dermis reticular, y son infrecuentes la angioplasia o el depósito de hemosiderina.</p><p class="elsevierStylePara">El caso clínico de nuestro paciente ilustra este cuadro clínico y la utilidad de los signos histológicos para diferenciar ambas etiologías.</p>" "pdfFichero" => "103v94n07a13051719pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec553798" "palabras" => array:1 [ 0 => "mucinosis, mixedema, dermatosis de piernas, enfermedad de Graves" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec553799" "palabras" => array:1 [ 0 => "mucinoses, myxedema, leg dermatoses, Graves' disease" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "El depósito pretibial de mucina puede ser un signo de la enfermedad de Graves (mixedema pretibial) o aparecer como consecuencia de una alteración en el retorno venoso o linfático. Es posible distinguir la etiología por los hallazgos histopatológicos. Presentamos un caso de mucinosis pretibial como manifestación de una dermatitis de estasis." ] "en" => array:1 [ "resumen" => "Pretibial mucin deposits may be a sign of Graves' disease (pretibial myxedema) or may appear as a result of a disorder in venous or lymphatic return. It is possible to distinguish the etiology through histopathological findings. We present a case of pretibial mucinosis as a manifestation of statis dermatitis." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "103v94n07-13051719fig01.jpg" "Alto" => 231 "Ancho" => 351 "Tamanyo" => 13217 ] ] "descripcion" => array:1 [ "es" => "--Placa pretibial izquierda." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "103v94n07-13051719fig02.jpg" "Alto" => 232 "Ancho" => 351 "Tamanyo" => 11085 ] ] "descripcion" => array:1 [ "es" => "--Depósito de mucina en la dermis papilar, sin zona grenz, y con angioplasia y hemosiderina (hematoxilina-eosina)." ] ] 2 => array:5 [ "identificador" => "fig3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 3 => array:5 [ "identificador" => "fig4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliograf¿a" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cutaneous mucinoses: microscopic criteria for diagnosis. Am J Dermatopathol 2001;23:257-67." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Cutaneous mucinoses: microscopic criteria for diagnosis." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Rongioletti F" 1 => "Rebora A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2001" "volumen" => "23" "paginaInicial" => "257" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11391115" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "A case of pretibial mucinosis without thyroid disease. J Dermatol 2002;29:383-5." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "A case of pretibial mucinosis without thyroid disease." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Kim KJ" 1 => "Kim HH" 2 => "Chang SE" 3 => "Choi JH" 4 => "Sung KJ" 5 => "Moon KC" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2002" "volumen" => "29" "paginaInicial" => "383" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12126079" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Euthyroid pretibial myxedema. Int J Dermatol 1992;31:431-2." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Euthyroid pretibial myxedema." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Srebrnik A" 1 => "Ophir J" 2 => "Brenner S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1992" "volumen" => "31" "paginaInicial" => "431" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1512100" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Euthyroid pretibial myxedema. Am J Med 1987;82:318-20." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Euthyroid pretibial myxedema." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Chen JJ" 1 => "Ladenson PW." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "1987" "volumen" => "82" "paginaInicial" => "318" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3812528" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pretibial mucin. Histologic patterns and clinical correlation. Arch Dermatol 1993;129:1152-6." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Pretibial mucin. Histologic patterns and clinical correlation." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Somach SC" 1 => "Helm TN" 2 => "Lawlor KB" 3 => "Bergfeld WF" 4 => "Bass J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1993" "volumen" => "129" "paginaInicial" => "1152" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8363399" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/00017310/0000009400000007/v0_201507151515/13051719/v0_201507151519/es/main.assets" "Apartado" => array:4 [ "identificador" => "6629" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Casos breves" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000009400000007/v0_201507151515/13051719/v0_201507151519/es/103v94n07a13051719pdf001.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051719?idApp=UINPBA000044" ]
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ISSN: 00017310Original language: Spanish
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| 2018 February | 44 | 9 | 53 |
| 2018 January | 37 | 9 | 46 |
| 2017 December | 52 | 10 | 62 |
| 2017 November | 50 | 15 | 65 |
| 2017 October | 40 | 18 | 58 |
| 2017 September | 47 | 29 | 76 |
| 2017 August | 30 | 35 | 65 |
| 2017 July | 63 | 27 | 90 |
| 2017 June | 73 | 35 | 108 |
| 2017 May | 92 | 29 | 121 |
| 2017 April | 54 | 52 | 106 |
| 2017 March | 65 | 102 | 167 |
| 2017 February | 186 | 45 | 231 |
| 2017 January | 50 | 22 | 72 |
| 2016 December | 77 | 32 | 109 |
| 2016 November | 107 | 50 | 157 |
| 2016 October | 142 | 59 | 201 |
| 2016 September | 164 | 55 | 219 |
| 2016 August | 88 | 42 | 130 |
| 2016 July | 60 | 30 | 90 |
| 2016 June | 10 | 12 | 22 |
| 2016 May | 8 | 12 | 20 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 7 | 6 | 13 |
| 2016 February | 6 | 7 | 13 |
| 2016 January | 11 | 17 | 28 |
| 2015 December | 14 | 22 | 36 |
| 2015 November | 29 | 28 | 57 |
| 2015 October | 26 | 16 | 42 |
| 2015 September | 22 | 21 | 43 |
| 2015 August | 21 | 10 | 31 |
| 2015 July | 81 | 8 | 89 |
| 2015 June | 59 | 7 | 66 |
| 2015 May | 74 | 11 | 85 |
| 2015 April | 67 | 8 | 75 |
| 2015 March | 51 | 8 | 59 |
| 2015 February | 48 | 9 | 57 |
| 2015 January | 45 | 9 | 54 |
| 2014 December | 52 | 8 | 60 |
| 2014 November | 92 | 12 | 104 |
| 2014 October | 73 | 16 | 89 |
| 2014 September | 50 | 11 | 61 |
| 2014 August | 66 | 22 | 88 |
| 2014 July | 57 | 20 | 77 |
| 2014 June | 59 | 12 | 71 |
| 2014 May | 61 | 14 | 75 |
| 2014 April | 39 | 12 | 51 |
| 2014 March | 48 | 28 | 76 |
| 2014 February | 36 | 23 | 59 |
| 2014 January | 52 | 29 | 81 |
| 2013 December | 33 | 26 | 59 |
| 2013 November | 46 | 37 | 83 |
| 2013 October | 42 | 36 | 78 |
| 2013 September | 50 | 34 | 84 |
| 2013 August | 38 | 64 | 102 |
| 2013 July | 54 | 39 | 93 |
| 2013 June | 35 | 42 | 77 |
| 2013 May | 44 | 18 | 62 |
| 2013 April | 36 | 19 | 55 |
| 2013 March | 38 | 22 | 60 |
| 2013 February | 57 | 17 | 74 |
| 2013 January | 50 | 11 | 61 |
| 2012 December | 26 | 9 | 35 |
| 2012 November | 32 | 9 | 41 |
| 2012 October | 24 | 6 | 30 |
| 2012 September | 15 | 1 | 16 |
| 2012 August | 1 | 0 | 1 |
| 2011 May | 3 | 0 | 3 |
| 2011 April | 10 | 0 | 10 |
| 2011 March | 9 | 0 | 9 |
| 2011 February | 6 | 0 | 6 |
| 2011 January | 8 | 0 | 8 |
| 2010 December | 16 | 0 | 16 |
| 2010 November | 10 | 0 | 10 |
| 2010 October | 5 | 0 | 5 |
| 2010 September | 18 | 0 | 18 |
| 2010 August | 5 | 0 | 5 |
| 2010 July | 2 | 0 | 2 |
| 2010 June | 1 | 0 | 1 |
| 2010 May | 9 | 0 | 9 |
| 2010 April | 11 | 0 | 11 |
| 2010 March | 2 | 0 | 2 |
| 2010 January | 3 | 0 | 3 |
| 2009 December | 1 | 0 | 1 |
| 2009 November | 1 | 0 | 1 |
| 2009 October | 5 | 0 | 5 |
| 2009 September | 6 | 0 | 6 |
| 2009 August | 4 | 0 | 4 |
| 2009 June | 3 | 0 | 3 |
| 2009 May | 4 | 0 | 4 |
| 2009 April | 2 | 0 | 2 |
| 2009 February | 3 | 0 | 3 |
| 2008 October | 3 | 0 | 3 |
| 2008 September | 2 | 0 | 2 |
| 2008 July | 2 | 0 | 2 |
| 2008 June | 1 | 0 | 1 |
| 2008 May | 2 | 0 | 2 |
| 2008 March | 1 | 0 | 1 |
| 2008 February | 1 | 0 | 1 |
| 2007 April | 1 | 0 | 1 |
Show all
