IMÁGENES EN DERMATOLOGÍA
Infiltración en el lóbulo: un caso curioso de cutis leucémico
Earlobe Infiltration: A Curious Case of Leukemia Cutis
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"apellidos" => "Aboobacker" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Venereología y Leprología, Christian Medical College, Vellore, Tamil Nadu, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Patología, Christian Medical Collegue, Vellore, Tamil Nadu, India" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Hematología, Christian Medical College, Vellore, Tamil Nadu, India" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Earlobe Infiltration: A Curious Case of Leukemia Cutis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 543 "Ancho" => 807 "Tamanyo" => 150600 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Un varón de 45 años de edad acudió con fiebre intermitente, pérdida de peso y apetito durante dos meses. En el examen se detectó linfadenopatía generalizada, infiltración eritematosa débil en los lóbulos (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A y B <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), y púrpuras lineales no palpables (víbices) que comprometían el tronco y las extremidades (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>C y D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Las pruebas cutáneas Slit® fueron negativas para bacilos ácidorresistentes. La biopsia del lóbulo derecho reveló infiltrado dérmico de linfocitos atípicos de moderado a denso, mostrando un alto ratio núcleo:citoplasma (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>A–C <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), positivo para CD34 (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>D), CD7 (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>E), mieloperoxidasa (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>F), TdT (<a class="elsevierStyleCrossRef" href="#fig0010">fig. 2</a>G), consistente con cutis leucémico (CL). Se detectaron blastocitos en la prueba periférica (18%) y el aspirado de la médula ósea (85%), siendo la inmunofenotipicación consistente con leucemia linfoblástica aguda (ALL) temprana de precursores de células T. No existía compromiso extramedular, por lo que se inició el protocolo para ALL en adultos.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La infiltración cutánea de células leucémicas en la leucemia sistémica o CL puede manifestarse en forma de pápulas, nódulos y placas solitarias/múltiples, localizadas/diseminadas, siendo infrecuentes los informes de otras presentaciones morfológicas, que a menudo imitan lesiones leucémicas cutáneas no específicas. Es más común entre los varones mayores, con leucemia mieloide aguda o leucemia linfocítica crónica (LLC).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">La infiltración en el lóbulo es una presentación interesante y localizada de CL, previamente reportada en la LLC, pero no en ALL<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>. La biopsia fue esencial para excluir otros diferenciales clínicos tales como lepra, linfomas, pseudolinfomas, rosácea granulomatosa, lupus vulgaris, sarcoidosis, perniosis lúpica.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 396 "Ancho" => 652 "Tamanyo" => 58751 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 543 "Ancho" => 807 "Tamanyo" => 150600 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukemia cutis – epidemiology, clinical presentation, and differential diagnoses: leukemia cutis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Wagner" 1 => "K. Fenchel" 2 => "W. Back" 3 => "A. Schulz" 4 => "M.M. Sachse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2011.07842.x" "Revista" => array:6 [ "tituloSerie" => "JDDG J Dtsch Dermatol Ges." "fecha" => "2012" "volumen" => "10" "paginaInicial" => "27" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115500" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukemia cutis in a patient with chronic lymphocytic leukemia presenting as bilateral helical nodules" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Raufi" 1 => "M. Alsharedi" 2 => "Y. Khelfa" 3 => "D.C. Griswold" 4 => "Y. Lebowicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2050313x16683624" "Revista" => array:3 [ "tituloSerie" => "SAGE Open Med Case Rep." "fecha" => "2016" "volumen" => "4" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/00017310/0000011400000004/v1_202304111712/S0001731023000844/v1_202304111712/es/main.assets" "Apartado" => array:4 [ "identificador" => "83194" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes en Dermatología" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000004/v1_202304111712/S0001731023000844/v1_202304111712/es/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023000844?idApp=UINPBA000044" ]
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