Urticaria Multiforme: A Report of 5 Cases and a Review of the Literature

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Sempau, E. Martín-Sáez, C. Gutiérrez-Rodríguez, M.C. Gutiérrez-Ortega" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Sempau" "email" => array:1 [ 0 => "leticiasempau@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Martín-Sáez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Gutiérrez-Rodríguez" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Gutiérrez-Ortega" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Burgos, Burgos, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cinco casos de urticaria multiforme y revisión de la literatura" ] ] "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" => 1105 "Ancho" => 1500 "Tamanyo" => 181480 ] ] "descripcion" => array:1 [ "en" => "Coalescing annular and archiform plaques with a violaceous center on the trunk (A and B), face (D), and limbs (C and E)." ] ] ] "textoCompleto" => "IntroductionUrticaria multiforme (UM) is a benign, self-resolving cutaneous disorder that affects children between 4 months and 4 years of age. It is characterized by the appearance of large annular and archiform erythematous plaques with a violaceous center and is very frequently accompanied by fever.Case DescriptionsWe present 5 cases of UM seen in our hospital between December 2012 and June 2013. Case data are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The patients—4 boys and 1 girl between the ages of 8 and 22 months—were brought to our emergency department following the appearance of extensive urticarial lesions on the face, trunk, and limbs. The lesions had a violaceous center and were associated with edema of the hands and feet (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Despite the striking clinical appearance of the skin, the patients were in good general health. Fever was a variable finding. The mean duration of the skin lesions was 5 days, during which time oral antihistamines or corticosteroids were administered to alleviate the lesions, but new lesions continued to appear. The first 2 patients seen were admitted to the hospital, whereas the last 3 only required ambulatory follow-up. All patients had received oral amoxicillin during the course of the disease or shortly before the skin lesions appeared; 3 underwent amoxicillin allergy tests, with negative results.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionUM is an acute skin disorder that typically affects infants and very small children and tends to be accompanied by fever and good general health. The typical lesions are initially small urticarial lesions that spread outward and coalesce into large archiform plaques with polycyclic borders and a violaceous center. The individual lesions have a duration of less than 24hours, can affect any part of the body, and tend to be associated with edema of the face, hands, and feet. The lesions disappear spontaneously in 6 to 10 days without leaving any residual pigmentation.UM was first described in 1997 by Tamayo-Sánchez et al.,<a class="elsevierStyleCrossRef" href="#bib0065">1</a> who observed 34 patients with a rash that they called acute annular urticaria and which they proposed differentiating from acute urticaria. Ten years later, Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> reported a new series of 19 cases and proposed the term urticaria multiforme because of the similarity of the entity to erythema multiforme. Unlike Tamayo-Sánchez et al., Shah et al. considered the disorder to be a subtype of urticaria because they found that the patients presented dermographism and pruritus, whereas Tamayo-Sánchez et al. had doubted whether pruritus was present because they did not find scratch lesions on any of their patients.The clinical diagnostic criteria that both authors agree on are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">–Large annular plaques with a transient ecchymotic center.</li><li class="elsevierStyleListItem" id="lsti0010">–Individual lesions with a duration of less than 24hours.</li><li class="elsevierStyleListItem" id="lsti0015">–Associated episode of fever.</li><li class="elsevierStyleListItem" id="lsti0020">–Total duration of disease: less than 10 days.</li><li class="elsevierStyleListItem" id="lsti0025">–Edema of the limbs.</li></ul>The etiology of UM is unknown. In the few reported cases in which the infectious agent was investigated, micoplasm,<a class="elsevierStyleCrossRefs" href="#bib0070">2,3</a> adenovirus,<a class="elsevierStyleCrossRef" href="#bib0070">2</a>Streptococcus organisms,<a class="elsevierStyleCrossRef" href="#bib0070">2</a> herpes virus 6,<a class="elsevierStyleCrossRef" href="#bib0080">4</a> and the Epstein-Barr virus<a class="elsevierStyleCrossRef" href="#bib0085">5</a> were detected. However, most reports indicate the medications that the patient had been receiving before the appearance of the lesions (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0065">1,2,5–10</a> Common medications include amoxicillin and furazolidone (an antibiotic used in the treatment of giardiasis in Mexico), which had been administered in 19 of the 34 cases reported by Tamayo-Sánchez. Likewise, vaccination in the days prior to symptom onset is frequently reported.<a class="elsevierStyleCrossRefs" href="#bib0070">2,9,10</a> In our series, all 5 patients had been taking amoxicillin at the time the lesions appeared or up to 3 days before the appearance of the lesions.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Histologic studies have been carried out in only 3 cases.<a class="elsevierStyleCrossRefs" href="#bib0065">1,5</a> In these patients, histology revealed dermal edema with a perivascular lymphocytic infiltrate and a few eosinophils, but no epidermal involvement. On the basis of these findings, UM can be differentiated from erythema multiforme (which is usually associated with epidermal necrosis) and from acute urticaria (which is not normally associated with perivascular lymphocytic infiltrate).The only treatment proposal put forth by Tamayo-Sánchez et al. is the introduction of antipyretics if fever is present and the suspension of suspicious medications, whereas Shah et al. recommend the use of antihistamines on the grounds that UM is a type of urticaria. All other authors propose the use of antihistamines for symptom relief.<a class="elsevierStyleCrossRefs" href="#bib0085">5,6,8–10</a> Our 5 patients initially received treatment with antihistamines, and oral corticosteroids were added when symptoms persisted. Both treatments alleviated the existing skin lesions but neither prevented the appearance of new lesions; we therefore doubt the utility of oral corticosteroids in UM. Like Tamayo-Sánchez et al., we observed no signs of scratching in our patients.The differential diagnosis of UM includes other annular lesions<a class="elsevierStyleCrossRefs" href="#bib0115">11,12</a> such as acute urticaria (which is usually associated with intense pruritus but not with fever and lacks central bluish pigmentation), erythema multiforme, and urticarial vasculitis (in which the individual lesions usually persist for several days and leave residual lesions. Facial and acral edema may require differential diagnosis with a drug-induced serum sickness–like reaction that is typically (but not exclusively) associated with the administration of cefaclor and vaccines. This type of reaction appears around 7 to 10 days after the start of treatment and presents as urticarial lesions with a dark center. In contrast to UM, however, the lesions do not have day-to-day fluctuation and tend to be associated with general malaise, arthralgia, and enlarged lymph nodes. Finally, it is important to differentiate UM from acute hemorrhagic edema of infancy, which also appears in children under 24 months of age in association with low-grade fever and has little impact on general health. Unlike UM, in acute hemorrhagic edema of infancy purpuric plaques appear and spread outward, forming annular, targetoid lesions, occasionally with a necrotic or bullous center, which last several days and leave residual pigmentation.ConclusionsThe 5 cases described in this article were seen over the course of 18 months, suggesting that UM is a relatively frequent entity in routine clinical practice. In all 5 cases, the patient had a history of upper respiratory tract infection and had been receiving amoxicillin in the days before the lesions appeared—a finding reported in practically all cases described in the literature. Because UM has an alarming appearance but a benign course, it is important that physicians be able to recognize it in order to reassure the family and avoid unnecessary hospital admissions and diagnostic tests.Ethical DisclosuresProtection of persons and animalsThe authors declare that no experiments were performed on humans or animals for the purpose of this study.Confidentiality of dataThe authors declare that they followed their hospitals’ regulations regarding the publication of patient information.Right to privacyThe authors declare that no private patient data appear in this article.Conflicts of InterestThe authors declare that they have no conflicts of interest." 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It is characterized by large, annular urticarial plaques with a violaceous center and is frequently accompanied by fever. Urticaria multiforme follows a benign, self-limiting course, but the striking appearance of the lesions can cause alarm and considerable anxiety among parents.We present 5 cases of urticaria multiforme seen in our hospital over a period of 18 months. All the cases were preceded by an infection of the upper airways or otitis, and they were all empirically with amoxicillin. It is important to be familiar with this condition to reassure parents and avoid unnecessary hospital admissions and tests." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La urticaria multiforme es un cuadro cutáneo, propio de lactantes y niños pequeños, caracterizado por la aparición de grandes placas anulares urticariformes de centro violáceo frecuentemente asociado a un proceso febril. Tiene un curso benigno y autolimitado, pero el llamativo aspecto de las lesiones puede ser alarmante y generar gran ansiedad en los padres.Presentamos 5 casos de urticaria multiforme vistos en nuestro hospital a lo largo de 18 meses. El antecedente común a todos ellos fue una infección de vías respiratorias altas u otitis por la que fueron tratados empíricamente con amoxicilina. Es importante saber reconocer esta entidad para tranquilizar a los padres, ahorrar el ingreso hospitalario y evitar la realización de pruebas diagnósticas innecesarias." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Sempau L, Martín-Sáez E, Gutiérrez-Rodríguez C, Gutiérrez-Ortega MC. Cinco casos de urticaria multiforme y revisión de la literatura. Actas Dermosifiliogr. 2016;107:e1–e5." ] ] "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" => 1105 "Ancho" => 1500 "Tamanyo" => 181480 ] ] "descripcion" => array:1 [ "en" => "Coalescing annular and archiform plaques with a violaceous center on the trunk (A and B), face (D), and limbs (C and E)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 949 "Ancho" => 1500 "Tamanyo" => 164298 ] ] "descripcion" => array:1 [ "en" => "Small urticarial lesions that spread outward leaving an ecchymotic center on the leg and foot (A), anterior aspect of the trunk (B), and posterior aspect of the trunk (C), coalescing until they occupy nearly the entire back." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: A, patient was taking medication when the cutaneous signs appeared; B, patient was taking usual medication; C, patient had been taking medication in the days prior to the appearance of urticaria multiforme." "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 5 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Medical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper respiratory tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper respiratory tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper respiratory tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Medication history and timing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Salbutamol, B Amoxicillin, A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Montelukast, B Fluticasone, B Amoxicillin, C (2 d) Dextromethorphan, C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin, A Paracetamol, A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin, A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin, C (2 d) Salbutamol, A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Timing of fever and skin rash \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever began 2 d after rash appeared \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever began 6h before rash appeared \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever until 1 d before rash appeared No fever while rash was present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low-grade fever while rash was present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever until 3 d before rash appeared No fever while rash was present \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of rash, d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6  \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Edema of hands and feet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Facial involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Annular plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Edema of the eyelids Annular plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Annular plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Edema of the eyelids Annular plaques \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Annular plaques \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydroxyzine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metamizole Hydroxyzine Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydroxyzine Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydroxyzine Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydroxyzine Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Antinuclear antibodies, negative Mycoplasma, negative Complete blood count, no abnormalities Biochemistry, no abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pharyngeal exudate, no abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukocytosis Biochemistry, no abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Allergy tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative for amoxicillin and dextromethorphan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative for amoxicillin and paracetamol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative for amoxicillin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1396743.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of Patient History in Our 5 Cases." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Article \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Furazolidone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tamayo-Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib0065">1</a> (×23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Amoxicillin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> (×5) Emer et al.<a class="elsevierStyleCrossRef" href="#bib0085">5</a> Donnelly and Tackett<a class="elsevierStyleCrossRef" href="#bib0090">6</a> Authried et al.<a class="elsevierStyleCrossRef" href="#bib0095">7</a> Guerrier et al.<a class="elsevierStyleCrossRef" href="#bib0100">8</a> Sempau (×5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Amoxicillin–clavulanic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Palivizumab (Synagis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Varicella vaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Unknown vaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Albuterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Topiramate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nitrofurantoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Aspirin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Guerrier et al.<a class="elsevierStyleCrossRef" href="#bib0100">8</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vaccine against rotavirus, Haemophilus influenzae, diphtheria, tetanus, and pertussis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Starnes et al.<a class="elsevierStyleCrossRef" href="#bib0105">9</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pyrazolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tamayo-Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib0065">1</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mesalamine+6-mercaptopurine+omeprazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shah et al.<a class="elsevierStyleCrossRef" href="#bib0070">2</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Naproxen+tetanus vaccine+human papillomavirus vaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fung et al.<a class="elsevierStyleCrossRef" href="#bib0110">10</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1396742.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Drugs and Vaccines Associated With Urticaria Multiforme in the Literature." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute 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Urticaria Multiforme: A Report of 5 Cases and a Review of the Literature

Cinco casos de urticaria multiforme y revisión de la literatura

L. Sempau

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leticiasempau@gmail.com

Corresponding author.

, E. Martín-Sáez, C. Gutiérrez-Rodríguez, M.C. Gutiérrez-Ortega

Servicio de Dermatología, Hospital Universitario de Burgos, Burgos, Spain

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    "titulo" => "Urticaria Multiforme&#58; A Report of 5 Cases and a Review of the Literature"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Coalescing annular and archiform plaques with a violaceous center on the trunk &#40;A and B&#41;&#44; face &#40;D&#41;&#44; and limbs &#40;C and E&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urticaria multiforme &#40;UM&#41; is a benign&#44; self-resolving cutaneous disorder that affects children between 4 months and 4 years of age&#46; It is characterized by the appearance of large annular and archiform erythematous plaques with a violaceous center and is very frequently accompanied by fever&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Descriptions</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present 5 cases of UM seen in our hospital between December 2012 and June 2013&#46; Case data are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The patients&#8212;4 boys and 1 girl between the ages of 8 and 22 months&#8212;were brought to our emergency department following the appearance of extensive urticarial lesions on the face&#44; trunk&#44; and limbs&#46; The lesions had a violaceous center and were associated with edema of the hands and feet &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Despite the striking clinical appearance of the skin&#44; the patients were in good general health&#46; Fever was a variable finding&#46; The mean duration of the skin lesions was 5 days&#44; during which time oral antihistamines or corticosteroids were administered to alleviate the lesions&#44; but new lesions continued to appear&#46; The first 2 patients seen were admitted to the hospital&#44; whereas the last 3 only required ambulatory follow-up&#46; All patients had received oral amoxicillin during the course of the disease or shortly before the skin lesions appeared&#59; 3 underwent amoxicillin allergy tests&#44; with negative results&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">UM is an acute skin disorder that typically affects infants and very small children and tends to be accompanied by fever and good general health&#46; The typical lesions are initially small urticarial lesions that spread outward and coalesce into large archiform plaques with polycyclic borders and a violaceous center&#46; The individual lesions have a duration of less than 24<span class="elsevierStyleHsp" style=""></span>hours&#44; can affect any part of the body&#44; and tend to be associated with edema of the face&#44; hands&#44; and feet&#46; The lesions disappear spontaneously in 6 to 10 days without leaving any residual pigmentation&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">UM was first described in 1997 by Tamayo-S&#225;nchez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> who observed 34 patients with a rash that they called acute annular urticaria and which they proposed differentiating from acute urticaria&#46; Ten years later&#44; Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> reported a new series of 19 cases and proposed the term <span class="elsevierStyleItalic">urticaria multiforme</span> because of the similarity of the entity to erythema multiforme&#46; Unlike Tamayo-S&#225;nchez et al&#46;&#44; Shah et al&#46; considered the disorder to be a subtype of urticaria because they found that the patients presented dermographism and pruritus&#44; whereas Tamayo-S&#225;nchez et al&#46; had doubted whether pruritus was present because they did not find scratch lesions on any of their patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical diagnostic criteria that both authors agree on are as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Large annular plaques with a transient ecchymotic center&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Individual lesions with a duration of less than 24<span class="elsevierStyleHsp" style=""></span>hours&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Associated episode of fever&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Total duration of disease&#58; less than 10 days&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Edema of the limbs&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">The etiology of UM is unknown&#46; In the few reported cases in which the infectious agent was investigated&#44; micoplasm&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;3</span></a> adenovirus&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">Streptococcus</span> organisms&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> herpes virus 6&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> and the Epstein-Barr virus<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> were detected&#46; However&#44; most reports indicate the medications that the patient had been receiving before the appearance of the lesions &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2&#44;5&#8211;10</span></a> Common medications include amoxicillin and furazolidone &#40;an antibiotic used in the treatment of giardiasis in Mexico&#41;&#44; which had been administered in 19 of the 34 cases reported by Tamayo-S&#225;nchez&#46; Likewise&#44; vaccination in the days prior to symptom onset is frequently reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;9&#44;10</span></a> In our series&#44; all 5 patients had been taking amoxicillin at the time the lesions appeared or up to 3 days before the appearance of the lesions&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Histologic studies have been carried out in only 3 cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;5</span></a> In these patients&#44; histology revealed dermal edema with a perivascular lymphocytic infiltrate and a few eosinophils&#44; but no epidermal involvement&#46; On the basis of these findings&#44; UM can be differentiated from erythema multiforme &#40;which is usually associated with epidermal necrosis&#41; and from acute urticaria &#40;which is not normally associated with perivascular lymphocytic infiltrate&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The only treatment proposal put forth by Tamayo-S&#225;nchez et al&#46; is the introduction of antipyretics if fever is present and the suspension of suspicious medications&#44; whereas Shah et al&#46; recommend the use of antihistamines on the grounds that UM is a type of urticaria&#46; All other authors propose the use of antihistamines for symptom relief&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a> Our 5 patients initially received treatment with antihistamines&#44; and oral corticosteroids were added when symptoms persisted&#46; Both treatments alleviated the existing skin lesions but neither prevented the appearance of new lesions&#59; we therefore doubt the utility of oral corticosteroids in UM&#46; Like Tamayo-S&#225;nchez et al&#46;&#44; we observed no signs of scratching in our patients&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The differential diagnosis of UM includes other annular lesions<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">11&#44;12</span></a> such as acute urticaria &#40;which is usually associated with intense pruritus but not with fever and lacks central bluish pigmentation&#41;&#44; erythema multiforme&#44; and urticarial vasculitis &#40;in which the individual lesions usually persist for several days and leave residual lesions&#46; Facial and acral edema may require differential diagnosis with a drug-induced serum sickness&#8211;like reaction that is typically &#40;but not exclusively&#41; associated with the administration of cefaclor and vaccines&#46; This type of reaction appears around 7 to 10 days after the start of treatment and presents as urticarial lesions with a dark center&#46; In contrast to UM&#44; however&#44; the lesions do not have day-to-day fluctuation and tend to be associated with general malaise&#44; arthralgia&#44; and enlarged lymph nodes&#46; Finally&#44; it is important to differentiate UM from acute hemorrhagic edema of infancy&#44; which also appears in children under 24 months of age in association with low-grade fever and has little impact on general health&#46; Unlike UM&#44; in acute hemorrhagic edema of infancy purpuric plaques appear and spread outward&#44; forming annular&#44; targetoid lesions&#44; occasionally with a necrotic or bullous center&#44; which last several days and leave residual pigmentation&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The 5 cases described in this article were seen over the course of 18 months&#44; suggesting that UM is a relatively frequent entity in routine clinical practice&#46; In all 5 cases&#44; the patient had a history of upper respiratory tract infection and had been receiving amoxicillin in the days before the lesions appeared&#8212;a finding reported in practically all cases described in the literature&#46; Because UM has an alarming appearance but a benign course&#44; it is important that physicians be able to recognize it in order to reassure the family and avoid unnecessary hospital admissions and diagnostic tests&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of persons and animals</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for the purpose of this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospitals&#8217; regulations regarding the publication of patient information&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Urticaria multiforme is a cutaneous disorder that affects infants and small children&#46; It is characterized by large&#44; annular urticarial plaques with a violaceous center and is frequently accompanied by fever&#46; Urticaria multiforme follows a benign&#44; self-limiting course&#44; but the striking appearance of the lesions can cause alarm and considerable anxiety among parents&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present 5 cases of urticaria multiforme seen in our hospital over a period of 18 months&#46; All the cases were preceded by an infection of the upper airways or otitis&#44; and they were all empirically with amoxicillin&#46; It is important to be familiar with this condition to reassure parents and avoid unnecessary hospital admissions and tests&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La urticaria multiforme es un cuadro cut&#225;neo&#44; propio de lactantes y ni&#241;os peque&#241;os&#44; caracterizado por la aparici&#243;n de grandes placas anulares urticariformes de centro viol&#225;ceo frecuentemente asociado a un proceso febril&#46; Tiene un curso benigno y autolimitado&#44; pero el llamativo aspecto de las lesiones puede ser alarmante y generar gran ansiedad en los padres&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Presentamos 5 casos de urticaria multiforme vistos en nuestro hospital a lo largo de 18 meses&#46; El antecedente com&#250;n a todos ellos fue una infecci&#243;n de v&#237;as respiratorias altas u otitis por la que fueron tratados emp&#237;ricamente con amoxicilina&#46; Es importante saber reconocer esta entidad para tranquilizar a los padres&#44; ahorrar el ingreso hospitalario y evitar la realizaci&#243;n de pruebas diagn&#243;sticas innecesarias&#46;</p></span>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; A&#44; patient was taking medication when the cutaneous signs appeared&#59; B&#44; patient was taking usual medication&#59; C&#44; patient had been taking medication in the days prior to the appearance of urticaria multiforme&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Medical history&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Upper respiratory tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Upper respiratory tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Upper respiratory tract infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Medication history<br>and timing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Salbutamol&#44; B<br>Amoxicillin&#44; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Montelukast&#44; B<br>Fluticasone&#44; B<br>Amoxicillin&#44; C &#40;2 d&#41;<br>Dextromethorphan&#44; C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amoxicillin&#44; A<br>Paracetamol&#44; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amoxicillin&#44; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amoxicillin&#44; C &#40;2 d&#41;<br>Salbutamol&#44; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Timing of<br>fever and skin rash&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever began 2 d after rash appeared&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever began 6<span class="elsevierStyleHsp" style=""></span>h before rash appeared&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever until 1 d before rash appeared<br>No fever while rash was present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low-grade fever while rash was present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fever until 3 d before rash appeared<br>No fever while rash was present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Duration of rash&#44; d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">General health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Edema of hands and feet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Facial involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annular plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Edema of the eyelids<br>Annular plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annular plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Edema of the eyelids<br>Annular plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annular plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hospitalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hydroxyzine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Metamizole<br>Hydroxyzine<br>Prednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hydroxyzine Prednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hydroxyzine<br>Prednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hydroxyzine<br>Prednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antinuclear antibodies&#44; negative<br><span class="elsevierStyleItalic">Mycoplasma</span>&#44; negative<br>Complete blood count&#44; no abnormalities<br>Biochemistry&#44; no abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pharyngeal exudate&#44; no abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leukocytosis<br>Biochemistry&#44; no abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Allergy tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative for<br>amoxicillin and<br>dextromethorphan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative for<br>amoxicillin and<br>paracetamol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative for amoxicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Summary of Patient History in Our 5 Cases&#46;</p>"
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      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Article&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Furazolidone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tamayo-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> &#40;&#215;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Amoxicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> &#40;&#215;5&#41;<br>Emer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a><br>Donnelly and Tackett<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a><br>Authried et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a><br>Guerrier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a><br>Sempau &#40;&#215;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Amoxicillin&#8211;clavulanic acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Palivizumab &#40;Synagis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Varicella vaccine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Unknown vaccine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Albuterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Topiramate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Nitrofurantoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Aspirin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guerrier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vaccine against rotavirus&#44; <span class="elsevierStyleItalic">Haemophilus influenzae</span>&#44; diphtheria&#44; tetanus&#44; and pertussis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Starnes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pyrazolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tamayo-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mesalamine<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>6-mercaptopurine<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>omeprazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Naproxen<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>tetanus vaccine<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>human papillomavirus vaccine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fung et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Drugs and Vaccines Associated With Urticaria Multiforme in the Literature&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute annular urticaria in infants and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Tamayo-S&#225;nchez"
                            1 => "R&#46; Ruiz-Maldonado"
                            2 => "A&#46; Laterza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "1997"
                        "volumen" => "14"
                        "paginaInicial" => "231"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9192421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "2"
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                        "volumen" => "119"
                        "paginaInicial" => "e1177"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19996054"
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                        "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed"
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                        "volumen" => "98"
                        "paginaInicial" => "F450"
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                        "paginaFinal" => "437"
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Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2015.11.010

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Year/Month	Html	Pdf	Total

2024 November	14	11	25
2024 October	145	66	211
2024 September	168	60	228
2024 August	179	90	269
2024 July	135	61	196
2024 June	129	72	201
2024 May	138	48	186
2024 April	96	46	142
2024 March	154	42	196
2024 February	186	46	232
2024 January	191	47	238
2023 December	232	31	263
2023 November	169	38	207
2023 October	236	50	286
2023 September	238	44	282
2023 August	270	32	302
2023 July	205	39	244
2023 June	168	22	190
2023 May	195	36	231
2023 April	182	20	202
2023 March	173	32	205
2023 February	155	24	179
2023 January	147	30	177
2022 December	130	49	179
2022 November	114	37	151
2022 October	95	44	139
2022 September	90	42	132
2022 August	100	38	138
2022 July	62	42	104
2022 June	80	50	130
2022 May	158	56	214
2022 April	143	39	182
2022 March	126	59	185
2022 February	130	35	165
2022 January	134	39	173
2021 December	115	51	166
2021 November	143	56	199
2021 October	78	57	135
2021 September	56	46	102
2021 August	64	25	89
2021 July	53	40	93
2021 June	63	39	102
2021 May	77	84	161
2021 April	95	73	168
2021 March	77	32	109
2021 February	82	43	125
2021 January	65	27	92
2020 December	74	28	102
2020 November	54	24	78
2020 October	56	51	107
2020 September	49	30	79
2020 August	40	26	66
2020 July	49	26	75
2020 June	50	35	85
2020 May	45	23	68
2020 April	47	26	73
2020 March	51	21	72
2020 February	13	3	16
2020 January	0	1	1
2019 December	6	1	7
2019 November	1	3	4
2019 October	2	5	7
2019 September	4	0	4
2019 June	2	0	2
2019 May	0	6	6
2019 April	2	2	4
2019 March	3	4	7
2019 February	1	1	2
2019 January	1	0	1
2018 December	3	0	3
2018 November	4	0	4
2018 October	16	0	16
2018 September	14	0	14
2018 March	20	1	21
2018 February	604	18	622
2018 January	341	21	362
2017 December	303	15	318
2017 November	189	12	201
2017 October	202	11	213
2017 September	161	16	177
2017 August	221	9	230
2017 July	254	14	268
2017 June	193	18	211
2017 May	190	15	205
2017 April	111	15	126
2017 March	82	17	99
2017 February	176	35	211
2017 January	119	15	134
2016 December	68	22	90
2016 November	503	31	534
2016 October	45	32	77
2016 August	1	0	1
2016 July	4	5	9
2016 May	5	0	5
2016 March	1	0	1
2016 February	8	12	20

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