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funci&#243;n hep&#225;tica y renal&#46; Destacan la importancia del recuento de eosin&#243;filos en el s&#237;ndrome DRESS y recuerdan la asociaci&#243;n de eosinofilia con la eritrodermia de causa maligna&#46; En este enfoque destacan la utilidad del recuento de c&#233;lulas de S&#233;zary en el diagn&#243;stico de a micosis fungoide-s&#237;ndrome de S&#233;zary&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dada la dificultad y la importancia del diagn&#243;stico de la eritrodermia paraneopl&#225;sica&#44; nos parece interesante proponer la inclusi&#243;n en el protocolo de Cuellar-Barboza et al<span class="elsevierStyleItalic">&#46;</span> de biomarcadores sencillos y accesibles que ayuden en al cribado de tumores asociados a eritrodermia&#46; En este sentido&#44; diferentes estudios han demostrado que niveles elevados de cianocobalamina &#40;vitamina B 12&#41; se correlacionan con un riesgo aumentado de neoplasias ocultas s&#243;lidas y hematol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1-8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La fisiopatogenia puede explicarse a partir del metabolismo de la cobalamina &#40;Cbl&#41;&#59; en condiciones normales&#44; la mayor parte de la Cbl en sangre &#40;80&#37;&#41; no circula libre&#44; debe unirse a prote&#237;nas transportadoras&#44; haptocorrina<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2-5</span></a> o bien transcobalamina de tipo <span class="elsevierStyleSmallCaps">i</span><a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5&#44;8</span></a>&#44; ambas pueden ser sintetizadas por c&#233;lulas de estirpe granuloc&#237;tica<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5</span></a> y los niveles de estas prote&#237;nas transportadoras en sangre est&#225;n correlacionados con los niveles de Cbl s&#233;rica&#46; Esto explicar&#237;a la hipercobalinemia en las discrasias sangu&#237;neas<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2-8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">No obstante&#44; 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por lo que la afectaci&#243;n hep&#225;tica tumoral primaria<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3&#44;8</span></a>&#44; metast&#225;sica<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;8</span></a> o por otras causas no tumorales<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;6&#44;8</span></a> har&#237;a posible la detecci&#243;n de hipercobalinemia s&#233;rica debido al menor aclaramiento de las prote&#237;nas ligadoras&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el art&#237;culo presentado por Arendt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> se concluye que&#44; a pesar de que la hipercobalinemia puede estar relacionada con tabaco&#44; el alcohol o la hepatopat&#237;a&#44; niveles superiores a 800<span class="elsevierStyleHsp" style=""></span>pmol&#47;l se relacionan significativamente con neoplasias&#44; en especial hematol&#243;gicas&#44; como el linfoma no Hodking&#44; linfoma tipo Hodking&#44; mieloma m&#250;ltiple y leucemia&#44; entre otros &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Adjuntamos el gr&#225;fico de Arendt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>&#44; en el que se indica el riesgo de diagnosticar diferentes tipos de tumores en el mismo a&#241;o en el que se determinan los niveles de Cbl plasm&#225;ticos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En este mismo sentido el art&#237;culo presentado por Chiche et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> demuestran la asociaci&#243;n estad&#237;sticamente significativa de niveles de vitamina B12 por encima de 1&#46;275 pg&#47;ml&#44; con la presencia de hemopat&#237;as malignas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En trabajos posteriores<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;6</span></a>&#44; obtienen similares resultados y se ha demostrado un peor pron&#243;stico y mayores tasas de mortalidad en pacientes con c&#225;ncer y niveles elevados de B12 respecto a aquellos pacientes con neoplasia y niveles normales de B12<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; creemos que ser&#237;a interesante incluir los niveles s&#233;ricos de Cbl en el protocolo de eritrodermia de los autores Cuellar-Barboza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> por ser una prueba sencilla&#44; barata y accesible para el despistaje de eritrodermia paraneopl&#225;sica y en especial de causa hemato-oncol&#243;gica&#46;</p></span>"
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CARTA AL DIRECTOR
Papel de la cianocobalamina en el abordaje práctico de la eritrodermia paraneoplásica
Role of Cyanocobalamin Levels in Managing Paraneoplastic Erythroderma: A Practical Approach
A. Andamoyo-Castañeda, E. Gómez-Moyano
Corresponding author
elisabeth.gomez.moyano@gmail.com

Autor para correspondencia.
, D.J. Godoy-Díaz, L. Martínez-Pilar
Departamento de Dermatología, Hospital Regional Universitario de Málaga, Málaga, España
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funci&#243;n hep&#225;tica y renal&#46; Destacan la importancia del recuento de eosin&#243;filos en el s&#237;ndrome DRESS y recuerdan la asociaci&#243;n de eosinofilia con la eritrodermia de causa maligna&#46; En este enfoque destacan la utilidad del recuento de c&#233;lulas de S&#233;zary en el diagn&#243;stico de a micosis fungoide-s&#237;ndrome de S&#233;zary&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dada la dificultad y la importancia del diagn&#243;stico de la eritrodermia paraneopl&#225;sica&#44; nos parece interesante proponer la inclusi&#243;n en el protocolo de Cuellar-Barboza et al<span class="elsevierStyleItalic">&#46;</span> de biomarcadores sencillos y accesibles que ayuden en al cribado de tumores asociados a eritrodermia&#46; En este sentido&#44; diferentes estudios han demostrado que niveles elevados de cianocobalamina &#40;vitamina B 12&#41; se correlacionan con un riesgo aumentado de neoplasias ocultas s&#243;lidas y hematol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1-8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La fisiopatogenia puede explicarse a partir del metabolismo de la cobalamina &#40;Cbl&#41;&#59; en condiciones normales&#44; la mayor parte de la Cbl en sangre &#40;80&#37;&#41; no circula libre&#44; debe unirse a prote&#237;nas transportadoras&#44; haptocorrina<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2-5</span></a> o bien transcobalamina de tipo <span class="elsevierStyleSmallCaps">i</span><a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5&#44;8</span></a>&#44; ambas pueden ser sintetizadas por c&#233;lulas de estirpe granuloc&#237;tica<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5</span></a> y los niveles de estas prote&#237;nas transportadoras en sangre est&#225;n correlacionados con los niveles de Cbl s&#233;rica&#46; Esto explicar&#237;a la hipercobalinemia en las discrasias sangu&#237;neas<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2-8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">No obstante&#44; en algunos carcinomas s&#243;lidos &#40;faringe&#44; esof&#225;gico&#44; hep&#225;tico&#44; g&#225;strico&#44; tracto biliar&#44; pancre&#225;tico&#44; pulm&#243;n&#44; renal&#44; colorrectal&#44; pr&#243;stata&#44; ovario&#44; c&#233;rvix&#44; vejiga&#44; etc&#46;&#41; tambi&#233;n se ha observado hipercobalinemia<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2-7</span></a>&#59; se podr&#237;a explicar a partir la s&#237;ntesis de transcobalamina tipo <span class="elsevierStyleSmallCaps">i</span> que puede estar aumentada por las propias c&#233;lulas neopl&#225;sicas<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;8</span></a>&#59; por otro lado&#44; la haptocorrina<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> y la transcobalamina tipo <span class="elsevierStyleSmallCaps">i</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> se metabolizan en el h&#237;gado&#44; por lo que la afectaci&#243;n hep&#225;tica tumoral primaria<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3&#44;8</span></a>&#44; metast&#225;sica<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;8</span></a> o por otras causas no tumorales<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;6&#44;8</span></a> har&#237;a posible la detecci&#243;n de hipercobalinemia s&#233;rica debido al menor aclaramiento de las prote&#237;nas ligadoras&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el art&#237;culo presentado por Arendt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> se concluye que&#44; a pesar de que la hipercobalinemia puede estar relacionada con tabaco&#44; el alcohol o la hepatopat&#237;a&#44; niveles superiores a 800<span class="elsevierStyleHsp" style=""></span>pmol&#47;l se relacionan significativamente con neoplasias&#44; en especial hematol&#243;gicas&#44; como el linfoma no Hodking&#44; linfoma tipo Hodking&#44; mieloma m&#250;ltiple y leucemia&#44; entre otros &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Adjuntamos el gr&#225;fico de Arendt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>&#44; en el que se indica el riesgo de diagnosticar diferentes tipos de tumores en el mismo a&#241;o en el que se determinan los niveles de Cbl plasm&#225;ticos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En este mismo sentido el art&#237;culo presentado por Chiche et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> demuestran la asociaci&#243;n estad&#237;sticamente significativa de niveles de vitamina B12 por encima de 1&#46;275 pg&#47;ml&#44; con la presencia de hemopat&#237;as malignas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En trabajos posteriores<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;6</span></a>&#44; obtienen similares resultados y se ha demostrado un peor pron&#243;stico y mayores tasas de mortalidad en pacientes con c&#225;ncer y niveles elevados de B12 respecto a aquellos pacientes con neoplasia y niveles normales de B12<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; creemos que ser&#237;a interesante incluir los niveles s&#233;ricos de Cbl en el protocolo de eritrodermia de los autores Cuellar-Barboza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> por ser una prueba sencilla&#44; barata y accesible para el despistaje de eritrodermia paraneopl&#225;sica y en especial de causa hemato-oncol&#243;gica&#46;</p></span>"
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Article information
ISSN: 00017310
Original language: Spanish
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