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codos y orejas&#46; No se observ&#243; compromiso ungueal&#44; no padeciendo el paciente artritis&#46; No se observaron lesiones cut&#225;neas sugerentes de sarcoidosis en cuero cabelludo&#44; tronco o extremidades&#44; incluyendo rodillas&#46; Los resultados de las pruebas de laboratorio revelaron elevaci&#243;n del valor de la enzima convertidora de angiotensina s&#233;rica &#40;34 U&#47;ml&#44; normal&#59; 8&#44;3-21&#44;4&#41;&#44; sIL-2R &#40;1&#46;850 U&#47;ml&#44; normal&#59; 121-613&#41; y reacci&#243;n negativa a la tuberculina&#46; No se detect&#243; sarcoidosis ocular ni cardiaca en la exploraci&#243;n detallada&#46; El examen histol&#243;gico de la lesi&#243;n en la rodilla mostr&#243; proliferaci&#243;n epid&#233;rmica regular&#44; infiltraci&#243;n intraepid&#233;rmica de neutr&#243;filos&#44; paraqueratosis&#44; dilataci&#243;n de vasos en la papila d&#233;rmica&#44; e infiltrados celulares perivasculares&#46; Se detectaron c&#233;lulas T CD4<span class="elsevierStyleSup">&#8722;</span> CD8<span class="elsevierStyleSup">&#43;</span> en la epidermis y dermis superior&#46; No se observaron granulomas sarcoideos en la dermis ni en subcutis&#46; Se trat&#243; al paciente con una pomada de corticosteroide t&#243;pica&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El paciente desarroll&#243; inicialmente psoriasis&#44; y cinco a&#241;os despu&#233;s se le diagnostic&#243; sarcoidosis&#46; Hab&#237;a sido tratado &#250;nicamente con terapia t&#243;pica y&#44; por tanto&#44; es poco probable que la sarcoidosis fuera inducida por los f&#225;rmacos para la psoriasis&#46; Ten&#237;a sarcoidosis ocular y pulmonar&#44; pero no se observaron lesiones sarcoideas cut&#225;neas&#44; al menos durante la visita inicial a nuestro departamento&#46; Hasta la fecha se han reportado diversos casos de coexistencia de psoriasis y sarcoidosis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Dichos casos presentan normalmente lesiones cut&#225;neas psori&#225;sicas y sarcoideas&#44; 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CARTA CIENTÍFICO-CLÍNICA
Psoriasis en placa en un paciente con sarcoidosis
Plaque Psoriasis in a Patient With Sarcoidosis
M. Ishikawa
Corresponding author
ishimasa@fmu.ac.jp

Autor para correspondencia.
, T. Yamamoto
Departamento de Dermatología, Fukushima Medical University, Fukushima, Japón
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Un var&#243;n de 65 a&#241;os fue ingresado en la unidad respiratoria de nuestro hospital&#44; para estudio detallado de una linfadenopat&#237;a hiliar bilateral&#46; El examen por tomograf&#237;a computarizada revel&#243; adenopat&#237;a &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; y la biopsia pulmonar por broncoscopia mostr&#243; granulomas epitelioides no caseificantes&#44; diagnostic&#225;ndose por tanto sarcoidosis&#46; Padec&#237;a tambi&#233;n diabetes mellitus desde hac&#237;a cinco a&#241;os&#46; Durante su ingreso fue remitido a nuestro departamento quej&#225;ndose de erupciones pruriginosas en brazos y o&#237;dos&#46; Manifest&#243; que se le hab&#237;a diagnosticado psoriasis ocho a&#241;os atr&#225;s&#44; tratada con corticosteroides t&#243;picos&#44; pero sin efecto suficiente&#46; En la exploraci&#243;n f&#237;sica se observaron placas eritematosas escamosas difusas en rodillas&#44; codos y orejas&#46; No se observ&#243; compromiso ungueal&#44; no padeciendo el paciente artritis&#46; No se observaron lesiones cut&#225;neas sugerentes de sarcoidosis en cuero cabelludo&#44; tronco o extremidades&#44; incluyendo rodillas&#46; Los resultados de las pruebas de laboratorio revelaron elevaci&#243;n del valor de la enzima convertidora de angiotensina s&#233;rica &#40;34 U&#47;ml&#44; normal&#59; 8&#44;3-21&#44;4&#41;&#44; sIL-2R &#40;1&#46;850 U&#47;ml&#44; normal&#59; 121-613&#41; y reacci&#243;n negativa a la tuberculina&#46; No se detect&#243; sarcoidosis ocular ni cardiaca en la exploraci&#243;n detallada&#46; El examen histol&#243;gico de la lesi&#243;n en la rodilla mostr&#243; proliferaci&#243;n epid&#233;rmica regular&#44; infiltraci&#243;n intraepid&#233;rmica de neutr&#243;filos&#44; paraqueratosis&#44; dilataci&#243;n de vasos en la papila d&#233;rmica&#44; e infiltrados celulares perivasculares&#46; Se detectaron c&#233;lulas T CD4<span class="elsevierStyleSup">&#8722;</span> CD8<span class="elsevierStyleSup">&#43;</span> en la epidermis y dermis superior&#46; No se observaron granulomas sarcoideos en la dermis ni en subcutis&#46; Se trat&#243; al paciente con una pomada de corticosteroide t&#243;pica&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El paciente desarroll&#243; inicialmente psoriasis&#44; y cinco a&#241;os despu&#233;s se le diagnostic&#243; sarcoidosis&#46; Hab&#237;a sido tratado &#250;nicamente con terapia t&#243;pica y&#44; por tanto&#44; es poco probable que la sarcoidosis fuera inducida por los f&#225;rmacos para la psoriasis&#46; Ten&#237;a sarcoidosis ocular y pulmonar&#44; pero no se observaron lesiones sarcoideas cut&#225;neas&#44; al menos durante la visita inicial a nuestro departamento&#46; Hasta la fecha se han reportado diversos casos de coexistencia de psoriasis y sarcoidosis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Dichos casos presentan normalmente lesiones cut&#225;neas psori&#225;sicas y sarcoideas&#44; mientras que nuestro paciente no exhibi&#243; sarcoidosis cut&#225;nea&#46; Las citocinas colaboradoras &#40;Th1&#41; son propiciadas en la fase inicial de la sarcoidosis&#46; En particular&#44; el factor de necrosis tumoral &#40;TNF&#41;-&#945; es importante en la formaci&#243;n de granuloma sarcoideo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Puede existir una patogenia mediada por TNF-&#945; compartida entre psoriasis y sarcoidosis&#46; TNF-&#945; activa las c&#233;lulas Th17 para causar la producci&#243;n de interleucina &#40;IL&#41;-17&#44; habi&#233;ndose sugerido que la v&#237;a inflamatoria de IL-17 es importante en la psoriasis&#46; De igual modo&#44; los estudios recientes han apuntado a un papel importante de IL-17 en la sarcoidosis&#44; habi&#233;ndose reflejado la expresi&#243;n realzada de interfer&#243;n-&#947;<span class="elsevierStyleSup">&#43;</span> de IL-17A<span class="elsevierStyleSup">&#43;</span> y c&#233;lulas T de memoria de IL-17A<span class="elsevierStyleSup">&#43;</span> IL-4<span class="elsevierStyleSup">&#43;</span> en pulmones con sarcoidosis<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; Por tanto&#44; se ha sugerido que el perfil de Th17 juega un papel en la sarcoidosis&#44; induciendo posiblemente la formaci&#243;n de granulomas <span class="elsevierStyleItalic">mediante</span> la supresi&#243;n de las c&#233;lulas T reguladoras<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; Otro estudio reflej&#243; la regulaci&#243;n al alza de IL-23 e IL-21 en las lesiones sarcoidales cut&#225;neas<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Adem&#225;s&#44; pso p27 es una prote&#237;na detectada en los mastocitos en las lesiones psori&#225;sicas&#44; extractables de las escamas psori&#225;sicas&#46; Pso p27 se expresa abundantemente en la piel psori&#225;sica&#44; y tambi&#233;n se incrementa la expresi&#243;n de pso p27 en los pulmones en la sarcoidosis pulmonar<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; El papel de pso p27 en la sarcoidosis es merecedor de estudios futuros&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0015" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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Article information
ISSN: 00017310
Original language: Spanish
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