Case Report
Splenic Marginal Zone B-Cell Lymphoma with Epidermotropic Skin Involvement
Linfoma B esplénico de la zona marginal con afectación cutánea epidermotropa
Read
12294
Timeswas read the article
2765
Total PDF
9529
Total HTML
Share statistics
array:24 [ "pii" => "S1578219012001692" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.003" "estado" => "S300" "fechaPublicacion" => "2012-06-01" "aid" => "449" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2012;103:427-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6660 "formatos" => array:3 [ "EPUB" => 60 "HTML" => 5757 "PDF" => 843 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731011003243" "issn" => "00017310" "doi" => "10.1016/j.ad.2011.06.004" "estado" => "S300" "fechaPublicacion" => "2012-06-01" "aid" => "449" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2012;103:427-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7592 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 4971 "PDF" => 2619 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Linfoma B esplénico de la zona marginal con afectación cutánea epidermotropa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "431" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Splenic Marginal Zone B-Cell Lymphoma With Epidermotropic Skin Involvement" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 759 "Ancho" => 950 "Tamanyo" => 123122 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Placas y nódulos infiltrados.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Gómez-de la Fuente, L.B. Villalón, L. Calzado-Villarreal, F. Pinedo-Moraleda, J.L. López-Estebaranz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Gómez-de la Fuente" ] 1 => array:2 [ "nombre" => "L.B." "apellidos" => "Villalón" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Calzado-Villarreal" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Pinedo-Moraleda" ] 4 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219012001692" "doi" => "10.1016/j.adengl.2012.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001692?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003243?idApp=UINPBA000044" "url" => "/00017310/0000010300000005/v1_201304241408/S0001731011003243/v1_201304241408/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219012001746" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.008" "estado" => "S300" "fechaPublicacion" => "2012-06-01" "aid" => "530" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:433-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4225 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 3392 "PDF" => 786 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for diagnosis</span>" "titulo" => "Sessile Nodule on the Gingival Mucosa" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "434" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulo sésil en mucosa gingival" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 599 "Ancho" => 475 "Tamanyo" => 71313 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Català, M. Alegre, A. Alomar, P. Domingo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Català" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Alegre" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Alomar" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Domingo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011005230" "doi" => "10.1016/j.ad.2011.08.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011005230?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001746?idApp=UINPBA000044" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001746/v1_201304241308/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219012001680" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.06.002" "estado" => "S300" "fechaPublicacion" => "2012-06-01" "aid" => "447" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2012;103:422-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4376 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 3557 "PDF" => 764 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Myxoid Dermatofibrosarcoma Protuberans in Childhood" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "422" "paginaFinal" => "426" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatofibrosarcoma protuberans mixoide infantil" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1129 "Ancho" => 850 "Tamanyo" => 461567 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Low-magnification image showing a spindle-cell neoformation which has diffusely infiltrated the reticular dermis and part of the subcutaneous tissue (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Campos, C. Zarco, F. Acquadro, E. Riveiro-Falkenbach, J.L. Rodríguez-Peralto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Campos" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Zarco" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Acquadro" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Riveiro-Falkenbach" ] 4 => array:2 [ "nombre" => "J.L." "apellidos" => "Rodríguez-Peralto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101100322X" "doi" => "10.1016/j.ad.2011.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101100322X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001680?idApp=UINPBA000044" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001680/v1_201304241308/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Splenic Marginal Zone B-Cell Lymphoma with Epidermotropic Skin Involvement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "431" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Gómez-de la Fuente, L.B. Villalón, L. Calzado-Villarreal, F. Pinedo-Moraleda, J.L. López-Estebaranz" "autores" => array:5 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gómez-de la Fuente" "email" => array:1 [ 0 => "egomezf@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.B." "apellidos" => "Villalón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Calzado-Villarreal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Pinedo-Moraleda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicios de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicios de Hematología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicios de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma B esplénico de la zona marginal con afectación cutánea epidermotropa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 759 "Ancho" => 950 "Tamanyo" => 123369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infiltrated plaques and nodules.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Marginal-zone B-cell lymphoma (MZL) is a neoplasm that originates in lymphocytes of the marginal zone, which is a compartment of lymphoid follicles that is highly developed in lymphoid organs with a high influx of antigens. The World Health Organization classification subdivides MZL into mucosa-associated lymphoid tissue (MALT) lymphoma and splenic or nodal lymphoma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The etiopathogenic process has been linked to chronic antigenic stimulus by self-antigens or bacteria such as <span class="elsevierStyleItalic">Borrelia burgdorferi</span> (cutaneous MZL) and <span class="elsevierStyleItalic">Helicobacter pylori</span> (gastric MZL) and viruses such as hepatitis C (splenic MZL). Although the clinical behavior of these different types of lymphoma may differ, they share similar morphologic features and have a similar immunophenotype: CD19+, CD20+, CD79a+, CD5-, CD10-, CD23-, bcl6-, and bcl2+. More than 70% of MZL, including the primary cutaneous forms, are of the MALT type, whereas splenic and nodal forms occur less frequently and account for only 1% of non-Hodgkin lymphomas. With MALT lymphoma and nodal MZL, there have been reports of cutaneous involvement,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but this is rare in the case of splenic MZL. We present a case of splenic MZL with epidermotropic skin involvement.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 68-year-old man with a history of hypertension and benign prostatic hyperplasia in treatment with doxazosin presented with erythematous-violaceous infiltrated plaques and nodules of 1-year duration. The lesions first appeared on the abdomen and then spread to the trunk and the roots of the limbs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He had no fever or other symptoms, except noninflammatory arthralgia. Lymph nodes were not palpable in the physical examination. His blood counts showed cytopenia (leukocytes 2000, neutrophils 700, and platelets 88 000). With a suspected diagnosis of a lymphoproliferative process, a skin biopsy was taken. This showed epidermotropic infiltration of the papillary and deep dermis. Intermediate-size lymphocytes with a centroid or monocytoid appearance were present in perivascular and interstitial areas between collagen bundles and in the basal layer of the epidermis. Immunohistochemical staining was positive for CD20, CD79a, bcl2, and immunoglobulin (Ig) D, and negative for CD3, CD5, CD10, bcl6, CD23, cyclin D1, multiple myeloma oncogene 1, and myeloperoxidase (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). With a provisional diagnosis of MZL, a staging study was performed. The same monoclonal rearrangement of the heavy chain Ig gene was detected in the bone marrow biopsy and peripheral blood analysis. A full biochemical analysis, protein analysis, and serology for <span class="elsevierStyleItalic">Borrelia burgdorferi</span> and for hepatitis virus B and C showed an increase in β<span class="elsevierStyleInf">2</span>-microglobulin (4.02<span class="elsevierStyleHsp" style=""></span>mg/L) and past hepatitis B infection (negative for hepatitis B surface antigen [HBsAg] and positive for anti-hepatitis B and anti-hepatitis B surface antibodies). The remaining parameters were normal or negative. Only mild superficial gastritis was detected in gastric endoscopy, and no <span class="elsevierStyleItalic">Helicobacter pylori</span> were isolated from the biopsy sample. The thoracoabdominal computed tomography showed massive splenomegalia. With a possible diagnosis of splenic MZL, splenectomy was performed. Almost all the lesions disappeared and bicytopenia resolved after 1 month (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Histologic study of the spleen showed a monomorphic micronodular proliferation with a immunophenotype similar to that of the cutaneous lesion except that IgD was negative. Study by fluorescence in situ hybridization for <span class="elsevierStyleItalic">MALT1</span> translocation was negative and PCR of IgH showed monoclonality. These findings confirmed the diagnosis of splenic MZL. Four months later new lesions appeared and the patient received 6 cycles of chemotherapy in combination with rituximab (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone]) every 3 weeks. The lesions disappeared after this treatment. However, 2 months later, hepatitis developed due to reactivation of the hepatitis B virus and the patient died despite receiving treatment with lamivudine.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Approximately 25% of primary cutaneous lymphomas are B-cell lymphomas, but in light of the lack of agreement on the classification of cutaneous B-cell lymphomas, the true incidence of MZL is unknown.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> According to some authors, MZL is the most frequent type of cutaneous B-cell lymphomas whereas others consider it to be relatively uncommon. Given the differences in behavior and prognosis of different types of MZL, it is important to determine when skin involvement in MZL is primary or secondary. By definition, a lymphoma is considered as a primary cutaneous malignancy if, on diagnosis or during the staging study, no other organ is found to be involved. In our patient, multiorgan involvement (skin, peripheral blood, bone marrow, and spleen) of the MZL was demonstrated. These characteristics are consistent with splenic MZL, which has an indolent course and presents with splenomegalia (almost 100% of the time), along with bone marrow involvement (95%) and peripheral blood involvement (75%).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> At times, autoimmune diseases may be associated with splenic MZL and can be the chief complaint. They were not, however, reported in this patient at any time during the course of the disease. In our case, cells from all involved areas had the same morphology and the same phenotype, suggesting that they originated from the same clone. In addition, the clinical course, in which the skin lesions all but disappeared and blood counts returned to normal after splenectomy, is evidence in favor of diagnosis of splenic lymphoma with secondary skin involvement. Skin involvement in MZL is exceptional and has only be reported occasionally.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Chiang et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> reported a patient with multiple papules on the trunk and thighs. Histology revealed MZL mimicking mycosis fungoides. The staging study in that case showed bone marrow involvement and splenomegalia, although histopathology of the spleen was not performed. The patient responded well to narrow-band UV-B phototherapy. In another study of a series of 85 cases of splenic MZL, Mollejo et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> singled out 4 cases with a diffuse pattern of infiltration. These lesions were negative for IgD and 2 of them were associated with epidermotropic skin involvement. The authors considered these lymphomas to be a variant of splenic MZL. They did not report the extent of skin involvement, so we do not know whether it was as severe as in our patient. Nevertheless, there are certain similarities with our case, such as intense involvement of the red pulp of the spleen, negative IgD status (splenic MZL usually expresses IgD), and epidermotropic skin involvement. Such epidermotropism is somewhat unusual and not reported in large series of primary cutaneous MZL,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> except for a study by Bathelier et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> who reported epidermotropism in 8% of cases. Of the 49 cases of MZL included in that series, 29 were primary cutaneous forms and 20 had systemic involvement though none had involvement of the spleen. The clinical features are not described, and it is not specified whether the cases of epidermotropism corresponded to primary or secondary MZL. In addition to this study and those of Chiang et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Mollejo et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> (which refer to secondary skin involvement in splenic MZL), we could only find 1 other report of primary cutaneous MZL with epidermotropism.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As is the case with cutaneous MZL, splenic MZL is usually indolent and a watchful waiting approach can be adopted. When treatment is indicated, splenectomy has usually been considered.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, new biologics such as rituximab (anti-CD20 monoclonal antibody) may also be administered although there is still some debate about its usefulness. Some authors are in favor of treatment with this drug, with or without associated chemotherapy, depending on the status of the patient.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The use of rituximab is, however, not without its risks. One of these is reactivation of hepatitis B, which can be fatal, as was the case in our patient. This complication may occur during or after treatment. Cases have been reported up to 12 months after discontinuation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The first patient with this complication was reported in 1999, and new cases were subsequently reported, almost always when rituximab was administered in combination with chemotherapy although there have also been reports after monotherapy.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> This makes it necessary to screen for hepatotoxic viruses, not only when patients are treated with rituximab but also in the case of treatment with other biologics widely used at present in dermatology such as anti-tumor necrosis factor agents.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In patients with prior hepatitis B infection (HBsAg-), viral DNA should be monitored to rule out reactivation. Prophylaxis should be given to patients positive for HBsAg as it has been found that no patients who received prophylactic treatment have died even in the presence of hepatitis B reactivation (compared to historical controls).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Nevertheless, there is no consensus regarding the prophylactic agent of choice (lamivudine, entecavir, or tenofovir) or the duration of treatment, that is, whether it should be longer because of the possibility of late reactivation or shorter because of the development of resistance with prolonged treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary, we present a rare case of MZL with skin involvement secondary to splenic MZL. Although histology does not generally allow differentiation between primary MZL and secondary MZL, we highlight that epidermotropism is common when cutaneous infiltration occurs in splenic MZL occurs but rare in primary cutaneous MZL. Finally, we would also like to emphasize the need to screen for the hepatitis virus before using immunosuppressive drugs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres95957" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec83115" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95956" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec83116" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec83115" "palabras" => array:4 [ 0 => "Marginal zone lymphoma" 1 => "Cutaneous marginal zone lymphoma" 2 => "Splenic lymphoma" 3 => "Rituximab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec83116" "palabras" => array:4 [ 0 => "Linfoma B de la zona marginal" 1 => "Linfoma cutáneo de la zona marginal" 2 => "Linfoma esplénico" 3 => "Rituximab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Marginal zone B-cell lymphoma (MZL) is subclassified into extranodal MZL of mucosa-associated lymphoid tissue (including cutaneous lymphomas), splenic MZL, and nodal MZL. We report the case of a 68-year-old man with erythematous-violaceous plaques and nodules. Skin biopsy showed an epidermotropic lymphocytic infiltration and cytology and immunohistochemistry were consistent with MZL. The workup revealed disease in the peripheral blood and bone marrow and massive splenomegaly. Splenectomy confirmed the diagnosis of splenic MZL and led to resolution of the skin lesions. Cutaneous recurrence was treated successfully with chemotherapy and rituximab but caused fatal hepatitis due to hepatitis B virus reactivation. Skin involvement by splenic MZL is uncommon; this form of the disease can present epidermotropism, a very rare finding in primary cutaneous MZL. Treatment consists of splenectomy, which may be associated with chemotherapy and/or rituximab; this treatment may lead to reactivation of latent hepatitis B infection and screening for hepatitis should therefore be performed prior to starting therapy.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El linfoma B de la zona marginal (LZM) se subdivide en LZM extraganglionar tipo MALT (incluye los cutáneos), esplénico y ganglionar. Presentamos el caso de un varón de 68 años con placas y nódulos eritematovioláceos. La biopsia cutánea mostró una infiltración linfocitaria epidermotropa con citología e inmunohistoquímica compatibles con LZM. El estudio de extensión mostró afectación de sangre periférica, médula ósea y esplenomegalia masiva. La esplenectomía confirmó el diagnóstico de LZM esplénico con desaparición de las lesiones cutáneas. Tras la recidiva cutánea se instauró quimioterapia/rituximab con desaparición de la misma, pero produciéndose una hepatitis letal por reactivación de virus de hepatitis B. La afectación cutánea por un LZM esplénico es un hallazgo infrecuente. Dicha afectación puede presentar epidermotropismo, hallazgo excepcional en los LZM cutáneos primarios. El tratamiento consiste en esplenectomía y/o quimioterapia y/o rituximab que pueden reactivar una hepatitis B inactiva, por lo que es preciso el <span class="elsevierStyleItalic">screening</span> de hepatitis antes de iniciarlos.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gómez-de la Fuente E, et al. Linforma B esplénico de la zona marginal con afectación cutánea epidermotropa. Actas Dermosifiliogr.2012;103:427-31.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 759 "Ancho" => 950 "Tamanyo" => 123369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infiltrated plaques and nodules.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1560 "Ancho" => 984 "Tamanyo" => 849619 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A, Cutaneous biopsy with epidermotropic tumoral infiltration of the entire dermis. Hematoxylin-eosin, original magnification x40. B, Detail of the same slide, original magnification x200.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1592 "Ancho" => 988 "Tamanyo" => 752626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A, Immunostaining with CD20. B, Immunostaining with bcl-20. Original magnification, x20 in both cases. Involvement of the entire epidermis and epidermotropism can be observed.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 699 "Ancho" => 1300 "Tamanyo" => 118250 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Almost complete disappearance of lesions 1 month after splenectomy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World Health Organisation Classification of Tumours: Pathology and Genetics: Tumours of Haemopoietic and Lymphoid Tissues" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.S. Jaffe" 1 => "N. Harris" 2 => "H. Stein" 3 => "J. Vardiman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2008" "editorial" => "IAR Press" "editorialLocalizacion" => "Lyon, France" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous involvement with marginal zone lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Gerami" 1 => "S.C. Wickless" 2 => "C. Querfeld" 3 => "S.T. Rosen" 4 => "T.M. Kuzel" 5 => "J. Guitart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.07.047" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "142" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20462658" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous marginal zone B-cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Kempf" 1 => "D.V. Kazakov" 2 => "G. Burg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cutaneous lymphomas" "paginaInicial" => "231" "paginaFinal" => "236" "serieFecha" => "2005" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y tratamiento de los linfomas cutáneos primarios de células B" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Gallardo" 1 => "R.M. Pujol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2004" "volumen" => "95" "paginaInicial" => "537" "paginaFinal" => "547" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic marginal zone lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Oscier" 1 => "R. Owen" 2 => "S. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.blre.2004.03.002" "Revista" => array:6 [ "tituloSerie" => "Blood Rev" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "39" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15572216" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous B-cell lymphoma with histologic features of mycosis fungoides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Chiang" 1 => "D.J. Di Caudio" 2 => "R. Valdez" 3 => "D.L. Swanson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.02.032" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "62" "paginaInicial" => "320" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19811849" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic small B-cell lymphoma with predominant red pulp involvement: a diffuse variant of splenic marginal zone lymphoma?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Mollejo" 1 => "P. Algara" 2 => "M.S. Mateo" 3 => "M. Sánchez-Beato" 4 => "E. Lloret" 5 => "M.T. Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Histopathology" "fecha" => "2002" "volumen" => "40" "paginaInicial" => "22" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11903595" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous marginal zone B-cell lymphoma: a clinical, histopathological, immunophenotypic and molecular genetic study of 22 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Servitje" 1 => "F. Gellardo" 2 => "T. Estrach" 3 => "R.M. Pujol" 4 => "A. Blanco" 5 => "A. Fernández-Sevilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "147" "paginaInicial" => "1147" "paginaFinal" => "1158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12452864" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous marginal zone B-cell lymphoma. Clinical and therapeutic features in 50 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Hoefnagel" 1 => "M.H. Vermeer" 2 => "P.M. Jansen" 3 => "F. Heule" 4 => "P.C. van Voors Vader" 5 => "C.J. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.141.9.1139" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "1139" "paginaFinal" => "1145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16172311" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marginal B-cell lymphoma affecting the skin: histological and phenotypic study of 49 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Bathelier" 1 => "L. Thomas" 2 => "B. Balme" 3 => "B. Coiffier" 4 => "F. Berger" 5 => "M. Ffrench" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annder.2008.07.057" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2008" "volumen" => "135" "paginaInicial" => "748" "paginaFinal" => "752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19061653" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous epidermotropic marginal B-cell lymphoma: a role for antihistamines in maintaining lymphoma cell growth?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.D. Pavlovic" 1 => "J. Kamarachev" 2 => "M. Adamic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2007.02522.x" "Revista" => array:6 [ "tituloSerie" => "JEADV" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "1012" "paginaFinal" => "1013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18503530" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of splenic marginal zone lymphoma: splenectomy versus rituximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Bennett" 1 => "G.P. Schechter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.seminhematol.2010.01.004" "Revista" => array:6 [ "tituloSerie" => "Semin Hematol" "fecha" => "2010" "volumen" => "47" "paginaInicial" => "143" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20350661" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late lethal hepatitis B virus reactivation after rituximab treatment of low-grade cutaneous B-cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Perceau" 1 => "N. Diris" 2 => "O. Estines" 3 => "C. Derancourt" 4 => "S. Levy" 5 => "P. Berenard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07451.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2006" "volumen" => "155" "paginaInicial" => "1053" "paginaFinal" => "1056" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17034541" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of patients with low grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Czuczman" 1 => "A.J. Grillo-Lopez" 2 => "C.A. White" 3 => "M. Saleh" 4 => "L. Gordon" 5 => "A.F. LoBuglio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/jco.1999.17.1.268" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "268" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10458242" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatits B virus reactivation in patient receiving chemotherapy for cancer treatment: role of lamivudine prophylaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Coiffier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/07357900600815232" "Revista" => array:6 [ "tituloSerie" => "Cancer Invest" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "548" "paginaFinal" => "552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16939967" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis: a rare, but important, complication of infliximab therapy for psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Wahie" 1 => "A. Alexandroff" 2 => "N.J. Reynolds" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2006.02086.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "460" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16681606" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001692/v1_201304241308/en/main.assets" "Apartado" => array:4 [ "identificador" => "6183" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000005/v1_201304241308/S1578219012001692/v1_201304241308/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001692?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 12 | 22 |
| 2024 October | 96 | 47 | 143 |
| 2024 September | 127 | 38 | 165 |
| 2024 August | 140 | 58 | 198 |
| 2024 July | 117 | 52 | 169 |
| 2024 June | 128 | 47 | 175 |
| 2024 May | 102 | 25 | 127 |
| 2024 April | 91 | 34 | 125 |
| 2024 March | 91 | 22 | 113 |
| 2024 February | 75 | 36 | 111 |
| 2024 January | 63 | 31 | 94 |
| 2023 December | 73 | 20 | 93 |
| 2023 November | 78 | 29 | 107 |
| 2023 October | 69 | 25 | 94 |
| 2023 September | 72 | 25 | 97 |
| 2023 August | 59 | 17 | 76 |
| 2023 July | 73 | 40 | 113 |
| 2023 June | 89 | 22 | 111 |
| 2023 May | 79 | 35 | 114 |
| 2023 April | 77 | 19 | 96 |
| 2023 March | 63 | 21 | 84 |
| 2023 February | 71 | 20 | 91 |
| 2023 January | 68 | 40 | 108 |
| 2022 December | 97 | 41 | 138 |
| 2022 November | 63 | 19 | 82 |
| 2022 October | 38 | 27 | 65 |
| 2022 September | 45 | 35 | 80 |
| 2022 August | 32 | 65 | 97 |
| 2022 July | 58 | 53 | 111 |
| 2022 June | 56 | 30 | 86 |
| 2022 May | 78 | 47 | 125 |
| 2022 April | 103 | 48 | 151 |
| 2022 March | 68 | 55 | 123 |
| 2022 February | 74 | 31 | 105 |
| 2022 January | 89 | 42 | 131 |
| 2021 December | 51 | 47 | 98 |
| 2021 November | 59 | 41 | 100 |
| 2021 October | 69 | 55 | 124 |
| 2021 September | 50 | 48 | 98 |
| 2021 August | 72 | 29 | 101 |
| 2021 July | 50 | 27 | 77 |
| 2021 June | 65 | 32 | 97 |
| 2021 May | 52 | 46 | 98 |
| 2021 April | 90 | 76 | 166 |
| 2021 March | 60 | 39 | 99 |
| 2021 February | 34 | 36 | 70 |
| 2021 January | 42 | 23 | 65 |
| 2020 December | 42 | 20 | 62 |
| 2020 November | 37 | 24 | 61 |
| 2020 October | 31 | 15 | 46 |
| 2020 September | 46 | 32 | 78 |
| 2020 August | 27 | 27 | 54 |
| 2020 July | 28 | 20 | 48 |
| 2020 June | 43 | 25 | 68 |
| 2020 May | 30 | 11 | 41 |
| 2020 April | 38 | 25 | 63 |
| 2020 March | 39 | 14 | 53 |
| 2020 February | 7 | 3 | 10 |
| 2020 January | 4 | 6 | 10 |
| 2019 December | 8 | 1 | 9 |
| 2019 November | 4 | 1 | 5 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 2 | 6 |
| 2019 July | 4 | 1 | 5 |
| 2019 June | 6 | 28 | 34 |
| 2019 May | 4 | 29 | 33 |
| 2019 April | 3 | 17 | 20 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 2 | 4 | 6 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 March | 4 | 0 | 4 |
| 2018 February | 141 | 7 | 148 |
| 2018 January | 94 | 7 | 101 |
| 2017 December | 149 | 5 | 154 |
| 2017 November | 50 | 8 | 58 |
| 2017 October | 58 | 5 | 63 |
| 2017 September | 67 | 9 | 76 |
| 2017 August | 76 | 19 | 95 |
| 2017 July | 66 | 2 | 68 |
| 2017 June | 80 | 13 | 93 |
| 2017 May | 63 | 11 | 74 |
| 2017 April | 45 | 4 | 49 |
| 2017 March | 48 | 45 | 93 |
| 2017 February | 48 | 13 | 61 |
| 2017 January | 64 | 9 | 73 |
| 2016 December | 106 | 17 | 123 |
| 2016 November | 153 | 14 | 167 |
| 2016 October | 167 | 19 | 186 |
| 2016 September | 213 | 8 | 221 |
| 2016 August | 155 | 13 | 168 |
| 2016 July | 63 | 12 | 75 |
| 2016 June | 22 | 16 | 38 |
| 2016 May | 8 | 16 | 24 |
| 2016 April | 8 | 5 | 13 |
| 2016 March | 7 | 0 | 7 |
| 2016 February | 5 | 1 | 6 |
| 2016 January | 11 | 2 | 13 |
| 2015 December | 8 | 4 | 12 |
| 2015 November | 187 | 6 | 193 |
| 2015 October | 67 | 1 | 68 |
| 2015 September | 12 | 4 | 16 |
| 2015 August | 9 | 6 | 15 |
| 2015 July | 262 | 15 | 277 |
| 2015 June | 182 | 11 | 193 |
| 2015 May | 231 | 9 | 240 |
| 2015 April | 233 | 7 | 240 |
| 2015 March | 286 | 15 | 301 |
| 2015 February | 214 | 9 | 223 |
| 2015 January | 173 | 16 | 189 |
| 2014 December | 178 | 16 | 194 |
| 2014 November | 167 | 15 | 182 |
| 2014 October | 161 | 24 | 185 |
| 2014 September | 152 | 14 | 166 |
| 2014 August | 128 | 19 | 147 |
| 2014 July | 129 | 26 | 155 |
| 2014 June | 131 | 17 | 148 |
| 2014 May | 91 | 9 | 100 |
| 2014 April | 81 | 4 | 85 |
| 2014 March | 79 | 10 | 89 |
| 2014 February | 79 | 10 | 89 |
| 2014 January | 57 | 8 | 65 |
| 2013 December | 63 | 10 | 73 |
| 2013 November | 61 | 12 | 73 |
| 2013 October | 54 | 7 | 61 |
| 2013 September | 48 | 14 | 62 |
| 2013 August | 36 | 9 | 45 |
| 2013 July | 19 | 42 | 61 |
| 2013 June | 13 | 27 | 40 |
| 2013 May | 12 | 13 | 25 |
| 2013 April | 13 | 24 | 37 |
| 2013 March | 21 | 15 | 36 |
| 2013 February | 28 | 5 | 33 |
| 2013 January | 29 | 3 | 32 |
| 2012 December | 25 | 6 | 31 |
| 2012 October | 0 | 2 | 2 |
| 2012 September | 1 | 1 | 2 |
| 2012 August | 2 | 2 | 4 |
Show all
