Case and Research Letters
Mixed Panniculitis Secondary to Interferon Beta-1a Therapy in a Woman With Multiple Sclerosis
Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple
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Hematoxilina-eosina (HE) ×40. b) Se aprecia un infiltrado mixto, compuesto principalmente por linfocitos con algunos neutrófilos. HE ×200.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Cuesta, M. Moragón, M. Pérez-Crespo, J. Onrubia, M. García" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Cuesta" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Moragón" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Pérez-Crespo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Onrubia" ] 4 => array:2 [ "nombre" => "M." 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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "261" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poroqueratosis de mibelli, ¿una nueva indicación de la terapia fotodinámica?" ] ] "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" => 1778 "Ancho" => 1335 "Tamanyo" => 435645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×20. Cornoid lamella (column of parakeratosis associated with hypogranulosis and dyskeratosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Gutiérrez Paredes, R. Bella Navarro, E. Montesinos Villaescusa, E. Jordá Cuevas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Gutiérrez Paredes" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Bella Navarro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Montesinos Villaescusa" ] 3 => array:2 [ "nombre" => "E." 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Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" ] 3 => array:2 [ "nombre" => "J." 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Cuesta, M. Moragón, M. Pérez-Crespo, J. Onrubia, M. García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Cuesta" "email" => array:1 [ 0 => "lcuestamontero@hotmail.com" ] "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" => "M." "apellidos" => "Moragón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Pérez-Crespo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Onrubia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario San Juan, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario San Juan, Alicante, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple" ] ] "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" => 1443 "Ancho" => 2167 "Tamanyo" => 583732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a, An infiltrate affecting the lobule and to a lesser extent, the septum. Septal thickening is also observed. Hematoxylin-eosin, original magnification ×40. b, Mixed infiltrate composed mainly of lymphocytes with some neutrophils. Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interferon beta was approved in Spain in 1995 for the treatment of progressive multiple sclerosis. There are 2 main types, interferon beta-1a and 1b, both of which are sold in a variety of formulations, resulting in a range of responses to the same molecule. Local skin reactions are a common adverse effect, and are usually self-limiting. By contrast, panniculitis and lipoatrophy are very rare, and may necessitate discontinuation of treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 43-year-old woman who was diagnosed in 2005 with multiple sclerosis, for which she received several disease-modifying treatments. In October 2009, she began treatment with interferon beta-1a (Rebif 44), which was self-administered subcutaneously 3 times a week, with a favorable response. After 18 months of treatment, induration was observed at the injection sites, on the back of the thighs, and on the outer arms. A few weeks later, ulcerated lesions appeared on the front of the thighs and progressively increased in size. The patient reported that the plaques caused severe pain, which made moving and walking difficult. She reported no fever or systemic upset and her neurological status remained unchanged.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination revealed 2 ulcers on the front of the thighs of 1<span class="elsevierStyleHsp" style=""></span>cm diameter. The borders of the ulcers had a scarlike appearance and beneath the ulcers were cavities of about 4<span class="elsevierStyleHsp" style=""></span>cm in diameter. An indurated plaque of about 15<span class="elsevierStyleHsp" style=""></span>cm in diameter, with a slightly erythematous surface, surrounded the ulcer and was intensely painful to touch (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These indurated plaques were also present on the external aspect of both arms, although no ulcers were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tissue culture of the ulcers and an incisional biopsy of a plaque from 1 of the thighs were negative. Histopathology revealed a preserved epidermis, sclerosis of the middle and deep dermis, and subcutaneous tissue involvement. At higher magnification we detected an infiltrate that primarily affected the lobule, although septal thickening was also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a); this infiltrate was composed mainly of neutrophils and lymphocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b). No vasculitis or necrosis was observed. Based on these observations, the patient was diagnosed with mixed panniculitis secondary to interferon beta-1a therapy. Upon consultation with her neurologist, it was decided to discontinue interferon beta-1a treatment, mainly due to functional impairment.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Interferon beta-1a was approved for the treatment of progressive multiple sclerosis in Spain in 1995. Its administration decreases the relapse rate by 30% and the appearance of new lesions on magnetic resonance imaging by 66%. Local skin manifestations such as erythema and pain are well-described frequent adverse effects; they occur in 63% to 85% of patients<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but are usually self-limiting and do not require discontinuation of treatment. However, treatment may need to be discontinued in cases of other more serious reactions such as ulcerations, necrosis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> sclerosis, and induration at the injection site. Other adverse effects such as sarcoid granulomas, lipoatrofia,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> lupus-like lesions,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and septal or lobular panniculitis<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> are considered very rare. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the cases of panniculitis secondary to interferon treatment described to date. Some authors have suggested that this form of panniculitis may be caused by the vascular toxicity of interferon beta.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In 2009, Ball and coworkers<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported that interferon beta-induced panniculitis can mimic pancreatic panniculitis; differential diagnosis in such cases may be facilitated by lipase and amylase tests.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two theories have been proposed regarding the pathophysiology of panniculitis secondary to interferon beta treatment. The first proposes that the stress associated with self-injection plays a key role in triggering this condition. The second theory attributes greater importance to the immunological effects of interferon beta. According to the latter theory, the resulting symptoms reflect activation of the immune system and may be an indication of treatment effectiveness.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The management of patients with panniculitis secondary to interferon beta treatment remains unsatisfactory. It is essential that patients are shown how to correctly self-administer the injection, which should be subcutaneous and never intradermal, and to rotate the injection sites daily. Application of these measures leads to improvements in the majority of lesions,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> although in some cases suspension of interferon beta treatment may be necessary, a decision that should be made in collaboration with the other specialists treating the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Cuesta L, et al. Paniculitis mixta secundaria al uso de interferón β 1A en una paciente con esclerosis múltiple. Actas Dermosifiliogr. 2013;104:257–9.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 1667 "Tamanyo" => 127300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated erythematous plaques with ulcerated centers on the front of both thighs.</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" => 1443 "Ancho" => 2167 "Tamanyo" => 583732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a, An infiltrate affecting the lobule and to a lesser extent, the septum. Septal thickening is also observed. Hematoxylin-eosin, original magnification ×40. b, Mixed infiltrate composed mainly of lymphocytes with some neutrophils. Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age, Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Onset of Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pathological Findings \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nakamura et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, induration, and pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perivascular dermatitis and lobular and septal panniculitis with lymphocytic infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ziegler et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Legs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, induration, and pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perivascular infiltrate and lobular panniculitis with lymphocytic infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heinzerling et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arms, legs and abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Painful induration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Septal panniculitis with predominantly lymphocytic infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O'Sullivan et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 y, 3 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema and pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Septal panniculitis with inflammatory infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ball et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not recorded \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 y, 10 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain and induration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lobular panniculitis with neutrophilic infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ball et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not recorded \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 y, 1 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lipomembranous panniculitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poulin et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythema, pain, and fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Septal panniculitis with predominantly lymphocytic infiltrate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Present case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Legs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain, erythema, induration, and functional impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lobular and septal panniculitis with mixed inflammatory infiltrate (lymphocytes and neutrophils) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183301.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients Described in the Literature Who Developed Panniculitis After Interferon Administration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon beta-1b injection site reactions and necroses" "autores" => array:1 [ 0 => array:2 [ "etal" => false 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Aberer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hautarzt" "fecha" => "1998" "volumen" => "49" "paginaInicial" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9606633" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0161642010008602" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Panniculitis after subcutaneous injection of interferon beta in a multiple sclerosis patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Heinzerling" 1 => "R. Dummer" 2 => "G. Burg" 3 => "P. Schmid-Grendelmeier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2002" "volumen" => "12" "paginaInicial" => "194" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11872423" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Panniculitis and lipoatrophy after subcutaneous injection of interferon beta-1b in a patient with multiple sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.S. O'Sullivan" 1 => "E.M. Cronin" 2 => "B.J. Sweeney" 3 => "J.F. Bourke" 4 => "J. Fitzgibbon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jnnp.2006.094813" "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "2006" "volumen" => "77" "paginaInicial" => "1382" "paginaFinal" => "1383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16782776" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lobular panniculitis at the site of subcutaneous interferon beta injections for the treatment of multiple sclerosis can histologically mimic pancreatic panniculitis. A study of 12 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.J. Ball" 1 => "B.J. Cowan" 2 => "S.A. Hashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2008.01019.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "331" "paginaFinal" => "337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19032383" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon beta-induced panniculitis mimicking acute appendicitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Poulin" 1 => "P. Rico" 2 => "J. Côté" 3 => "L.R. Bégin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.106" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2009" "volumen" => "145" "paginaInicial" => "916" "paginaFinal" => "917" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19687423" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000450/v1_201304241622/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000003/v1_201304241622/S1578219013000450/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000450?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 15 | 27 |
| 2024 October | 72 | 39 | 111 |
| 2024 September | 102 | 38 | 140 |
| 2024 August | 103 | 43 | 146 |
| 2024 July | 97 | 42 | 139 |
| 2024 June | 91 | 41 | 132 |
| 2024 May | 85 | 36 | 121 |
| 2024 April | 71 | 21 | 92 |
| 2024 March | 81 | 24 | 105 |
| 2024 February | 62 | 36 | 98 |
| 2024 January | 90 | 38 | 128 |
| 2023 December | 76 | 22 | 98 |
| 2023 November | 141 | 29 | 170 |
| 2023 October | 135 | 25 | 160 |
| 2023 September | 164 | 31 | 195 |
| 2023 August | 81 | 24 | 105 |
| 2023 July | 76 | 29 | 105 |
| 2023 June | 65 | 23 | 88 |
| 2023 May | 77 | 26 | 103 |
| 2023 April | 60 | 20 | 80 |
| 2023 March | 52 | 14 | 66 |
| 2023 February | 40 | 21 | 61 |
| 2023 January | 43 | 27 | 70 |
| 2022 December | 64 | 31 | 95 |
| 2022 November | 36 | 20 | 56 |
| 2022 October | 46 | 27 | 73 |
| 2022 September | 52 | 38 | 90 |
| 2022 August | 31 | 31 | 62 |
| 2022 July | 41 | 33 | 74 |
| 2022 June | 43 | 27 | 70 |
| 2022 May | 84 | 28 | 112 |
| 2022 April | 59 | 30 | 89 |
| 2022 March | 64 | 48 | 112 |
| 2022 February | 49 | 31 | 80 |
| 2022 January | 66 | 33 | 99 |
| 2021 December | 48 | 36 | 84 |
| 2021 November | 41 | 38 | 79 |
| 2021 October | 80 | 47 | 127 |
| 2021 September | 58 | 36 | 94 |
| 2021 August | 44 | 18 | 62 |
| 2021 July | 55 | 38 | 93 |
| 2021 June | 35 | 29 | 64 |
| 2021 May | 35 | 29 | 64 |
| 2021 April | 81 | 70 | 151 |
| 2021 March | 82 | 24 | 106 |
| 2021 February | 85 | 28 | 113 |
| 2021 January | 43 | 20 | 63 |
| 2020 December | 47 | 13 | 60 |
| 2020 November | 32 | 4 | 36 |
| 2020 October | 26 | 14 | 40 |
| 2020 September | 21 | 8 | 29 |
| 2020 August | 41 | 19 | 60 |
| 2020 July | 24 | 17 | 41 |
| 2020 June | 38 | 20 | 58 |
| 2020 May | 29 | 13 | 42 |
| 2020 April | 31 | 24 | 55 |
| 2020 March | 41 | 14 | 55 |
| 2020 February | 2 | 2 | 4 |
| 2020 January | 0 | 4 | 4 |
| 2019 December | 4 | 8 | 12 |
| 2019 November | 0 | 8 | 8 |
| 2019 October | 1 | 2 | 3 |
| 2019 September | 4 | 7 | 11 |
| 2019 August | 0 | 5 | 5 |
| 2019 July | 0 | 11 | 11 |
| 2019 June | 2 | 3 | 5 |
| 2019 May | 0 | 3 | 3 |
| 2019 April | 0 | 9 | 9 |
| 2019 March | 2 | 17 | 19 |
| 2019 January | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 4 | 0 | 4 |
| 2018 August | 0 | 4 | 4 |
| 2018 June | 0 | 6 | 6 |
| 2018 May | 0 | 4 | 4 |
| 2018 April | 0 | 2 | 2 |
| 2018 March | 1 | 3 | 4 |
| 2018 February | 121 | 7 | 128 |
| 2018 January | 104 | 5 | 109 |
| 2017 December | 114 | 4 | 118 |
| 2017 November | 80 | 9 | 89 |
| 2017 October | 56 | 6 | 62 |
| 2017 September | 63 | 5 | 68 |
| 2017 August | 80 | 11 | 91 |
| 2017 July | 67 | 9 | 76 |
| 2017 June | 95 | 10 | 105 |
| 2017 May | 67 | 14 | 81 |
| 2017 April | 50 | 10 | 60 |
| 2017 March | 59 | 7 | 66 |
| 2017 February | 41 | 10 | 51 |
| 2017 January | 92 | 14 | 106 |
| 2016 December | 87 | 9 | 96 |
| 2016 November | 146 | 7 | 153 |
| 2016 October | 177 | 12 | 189 |
| 2016 September | 223 | 16 | 239 |
| 2016 August | 209 | 8 | 217 |
| 2016 July | 74 | 10 | 84 |
| 2016 June | 6 | 15 | 21 |
| 2016 May | 4 | 11 | 15 |
| 2016 April | 6 | 9 | 15 |
| 2016 March | 4 | 1 | 5 |
| 2016 February | 5 | 16 | 21 |
| 2016 January | 9 | 1 | 10 |
| 2015 December | 7 | 9 | 16 |
| 2015 November | 35 | 14 | 49 |
| 2015 October | 34 | 13 | 47 |
| 2015 September | 21 | 5 | 26 |
| 2015 August | 9 | 4 | 13 |
| 2015 July | 232 | 12 | 244 |
| 2015 June | 118 | 13 | 131 |
| 2015 May | 153 | 19 | 172 |
| 2015 April | 116 | 16 | 132 |
| 2015 March | 102 | 8 | 110 |
| 2015 February | 119 | 5 | 124 |
| 2015 January | 67 | 2 | 69 |
| 2014 December | 80 | 3 | 83 |
| 2014 November | 59 | 3 | 62 |
| 2014 October | 72 | 2 | 74 |
| 2014 September | 86 | 3 | 89 |
| 2014 August | 66 | 4 | 70 |
| 2014 July | 63 | 3 | 66 |
| 2014 June | 83 | 5 | 88 |
| 2014 May | 66 | 8 | 74 |
| 2014 April | 60 | 6 | 66 |
| 2014 March | 66 | 12 | 78 |
| 2014 February | 40 | 8 | 48 |
| 2014 January | 42 | 7 | 49 |
| 2013 December | 25 | 10 | 35 |
| 2013 November | 16 | 6 | 22 |
| 2013 October | 5 | 7 | 12 |
| 2013 September | 14 | 3 | 17 |
| 2013 August | 7 | 7 | 14 |
| 2013 July | 3 | 1 | 4 |
| 2013 June | 2 | 5 | 7 |
| 2013 May | 0 | 5 | 5 |
| 2013 April | 1 | 2 | 3 |
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