Case and Research Letter
Concomitant Pyoderma Gangrenosum and Erythema Nodosum in a Patient With Ulcerative Colitis
Pioderma gangrenoso concomitante y eritema nudoso en paciente con colitis ulcerosa
N. Kikuchi
, N. Matsumura, T. Hiraiwa, Y. Kato, M. Satoh, T. Yamamoto
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Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Kikuchi, N. Matsumura, T. Hiraiwa, Y. Kato, M. Satoh, T. Yamamoto" "autores" => array:6 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Kikuchi" "email" => array:1 [ 0 => "nobuyuk@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Matsumura" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Hiraiwa" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Kato" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Satoh" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Yamamoto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pioderma gangrenoso concomitante y eritema nudoso en paciente con colitis ulcerosa" ] ] "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" => 1345 "Ancho" => 1797 "Tamanyo" => 389042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Deep ulcerative lesions on the lower leg. (B) Histological features showing a dense neutrophil infiltrate in the upper to mid-dermis. Hematoxylin and eosin (H&E), original magnification ×40. (C) Higher magnification reveals prominent neutrophil infiltration and extravasation of red blood cells. H&E, original magnification ×400. (D) Painful, subcutaneous erythematous nodules on the knee. (E) Histology shows cellular infiltrates most intense in the subcutaneous septa. H&E, original magnification ×40.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old woman was admitted to our hospital with a painful ulcer on her leg and fever of over 38<span class="elsevierStyleHsp" style=""></span>°C. She had been diagnosed with ulcerative colitis (UC) 14 years earlier and was on treatment with mesalazine, 3600<span class="elsevierStyleHsp" style=""></span>mg/d, and prednisolone at doses of up to 40<span class="elsevierStyleHsp" style=""></span>mg/d. Infliximab, 5<span class="elsevierStyleHsp" style=""></span>mg/kg, plus azathioprine, 50<span class="elsevierStyleHsp" style=""></span>mg/d, had been added to her treatment a year prior to admission and had been administered 8 times in total. The patient also reported atopic dermatitis since childhood. One week prior to admission she experienced painful erythema of sudden onset on the lower leg; the lesion became ulcerated 4 days later. She denied any history of trauma or bruising.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a very tender ulcer measuring 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>cm on the left lower leg (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The ulcer had irregular, elevated borders with edema. Laboratory tests revealed a white blood cell count of 7100<span class="elsevierStyleHsp" style=""></span>cells/μL, with 67% neutrophils, and elevation of C-reactive protein levels (9.15<span class="elsevierStyleHsp" style=""></span>mg/dL) and of the erythrocyte sedimentation rate (39<span class="elsevierStyleHsp" style=""></span>mm/h). Serum levels of interleukin (IL) 8 were extremely high (1860<span class="elsevierStyleHsp" style=""></span>pg/mL). Bacterial culture was sterile. A biopsy taken from the border of the ulcer showed a diffuse neutrophil infiltrate in the dermis and subcutaneous adipose tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C). On the second day of hospitalization, the patient developed tender erythema on both her lower legs and on her right thigh. Physical examination revealed a number of poorly defined, indurated, pale pink-erythematous papules measuring 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm on the right knee (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D) and on both lower legs. On histology, a neutrophilic infiltrate was observed in the subcutaneous adipose tissue (most intense in the septa) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). The ulcer had reepithelialized completely 2 months after starting treatment with systemic prednisolone, 25<span class="elsevierStyleHsp" style=""></span>mg/d. The prednisolone dose was then gradually tapered to complete withdrawal 5 months later, with no relapse of the pyoderma gangrenosum (PG). Both infliximab and azathioprine were continued throughout the course of steroid treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PG and erythema nodosum (EN) are skin lesions associated with UC.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In general, such manifestations appear to be related to activity of the intestinal disease; however, some patients develop skin lesions despite remission of their bowel condition. Our patient developed a deep ulcer on her lower leg, followed by painful erythematous subcutaneous nodules at an interval of several days, despite control of her intestinal disease. To date, counting our patient, only 5 five cases of concomitant PG and EN have been reported.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> The details of these patients, all women aged between 19 and 49 years, are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. One patient had Crohn disease, the other 4 had UC. Skin symptoms appeared simultaneously with an exacerbation of the intestinal disease in all cases except in our patient. Arthritis was observed in 1 case. Systemic steroids were used in 4 cases, with an adequate response, and 1 case was successfully treated using tacrolimus and granulocytapheresis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Very rarely, PG can be induced by tumor necrosis factor (TNF) inhibitors<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a>; however, we ruled out the possibility of biologics-induced PG in our patient because the administration of infliximab to control her intestinal symptoms after the onset of her PG and EN did not exacerbate either the skin or the joint manifestations. Furthermore, azathioprine was continued throughout the course of steroid treatment, indicating that PG and EN were not related to azathioprine.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Our patient complained of flu-like symptoms, such as rhinitis and fever, which may have triggered neutrophil activation and recruitment to the skin via chemokines such as IL-8, a potent neutrophil chemoattractant. Neutrophil priming can occur in response to a number of stimuli, including TNF-α, IL-8, and granulocyte macrophage-colony stimulating factor. In the present case, serum IL-8 was very significantly elevated; this interleukin is also able to induce the production of reactive oxygen species, leading to skin damage.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A further factor to be taken into account in our patient was that she had had atopic dermatitis since childhood. Previous studies have shown an association between atopic dermatitis and UC,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and an increased risk of inflammatory bowel disease among patients with atopic dermatitis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> However, other studies have not observed a statistically significant increase in the prevalence of atopic dermatitis among patients with UC compared with healthy controls.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Possible mechanisms may include an impaired barrier function, potential sharing of type 2 T-helper cell cytokines, and thymic stromal lymphopoietin (TSLP).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary, we have described the rare case of a patient with UC who developed concurrent PG and EN not related to the activity of her intestinal disease. Reporting of similar cases will help to clarify the mechanisms of the aseptic neutrophilic disorders, such as the so-called aseptic abscess syndrome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1345 "Ancho" => 1797 "Tamanyo" => 389042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Deep ulcerative lesions on the lower leg. (B) Histological features showing a dense neutrophil infiltrate in the upper to mid-dermis. Hematoxylin and eosin (H&E), original magnification ×40. (C) Higher magnification reveals prominent neutrophil infiltration and extravasation of red blood cells. H&E, original magnification ×400. (D) Painful, subcutaneous erythematous nodules on the knee. (E) Histology shows cellular infiltrates most intense in the subcutaneous septa. H&E, original magnification ×40.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CD, Crohn disease; EN, erythema nodosum; F, female; IBD, inflammatory bowel disease; M, male; PG, pyoderma gangrenosum; UC, ulcerative colitis.</p>" "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">Case \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">Age/sex \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">IBD \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">Duration of IBD, y \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">Control of IBD \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">Arthritis \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">PG \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">EN \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">Time lag \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">Therapy \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">Reference \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="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exacerbation \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">Scalp, face, trunk, extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Calf \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simultaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydrocortisone, azathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0055">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="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exacerbation \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">Popliteal fossa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simultaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydrocortisone, ciclosporin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0055">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="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exacerbation \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">Calf \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Simultaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydrocortisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0055">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="char" 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">44/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exacerbation \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">Back, thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tacrolimus, granulocytapheresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0060">3</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="char" 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">40/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stable \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">Lower leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower leg, thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Present case \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260388.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical features of patients with inflammatory bowel disease and concomitant pyoderma gangrenosum and erythema nodosum.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin manifestations of inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 6 | 11 |
| 2024 Octubre | 54 | 36 | 90 |
| 2024 Septiembre | 60 | 21 | 81 |
| 2024 Agosto | 75 | 48 | 123 |
| 2024 Julio | 46 | 25 | 71 |
| 2024 Junio | 64 | 21 | 85 |
| 2024 Mayo | 47 | 30 | 77 |
| 2024 Abril | 47 | 29 | 76 |
| 2024 Marzo | 55 | 29 | 84 |
| 2024 Febrero | 33 | 28 | 61 |
| 2024 Enero | 46 | 28 | 74 |
| 2023 Diciembre | 47 | 19 | 66 |
| 2023 Noviembre | 65 | 29 | 94 |
| 2023 Octubre | 55 | 14 | 69 |
| 2023 Septiembre | 46 | 26 | 72 |
| 2023 Agosto | 46 | 7 | 53 |
| 2023 Julio | 68 | 25 | 93 |
| 2023 Junio | 48 | 17 | 65 |
| 2023 Mayo | 44 | 22 | 66 |
| 2023 Abril | 37 | 25 | 62 |
| 2023 Marzo | 53 | 24 | 77 |
| 2023 Febrero | 49 | 24 | 73 |
| 2023 Enero | 33 | 31 | 64 |
| 2022 Diciembre | 52 | 32 | 84 |
| 2022 Noviembre | 41 | 49 | 90 |
| 2022 Octubre | 60 | 34 | 94 |
| 2022 Septiembre | 46 | 51 | 97 |
| 2022 Agosto | 46 | 43 | 89 |
| 2022 Julio | 44 | 36 | 80 |
| 2022 Junio | 42 | 24 | 66 |
| 2022 Mayo | 49 | 33 | 82 |
| 2022 Abril | 72 | 35 | 107 |
| 2022 Marzo | 79 | 54 | 133 |
| 2022 Febrero | 69 | 22 | 91 |
| 2022 Enero | 77 | 45 | 122 |
| 2021 Diciembre | 45 | 39 | 84 |
| 2021 Noviembre | 63 | 44 | 107 |
| 2021 Octubre | 56 | 64 | 120 |
| 2021 Septiembre | 51 | 51 | 102 |
| 2021 Agosto | 39 | 23 | 62 |
| 2021 Julio | 31 | 30 | 61 |
| 2021 Junio | 36 | 40 | 76 |
| 2021 Mayo | 37 | 36 | 73 |
| 2021 Abril | 74 | 98 | 172 |
| 2021 Marzo | 62 | 43 | 105 |
| 2021 Febrero | 52 | 28 | 80 |
| 2021 Enero | 38 | 24 | 62 |
| 2020 Diciembre | 24 | 16 | 40 |
| 2020 Noviembre | 31 | 23 | 54 |
| 2020 Octubre | 27 | 20 | 47 |
| 2020 Septiembre | 34 | 14 | 48 |
| 2020 Agosto | 28 | 23 | 51 |
| 2020 Julio | 46 | 14 | 60 |
| 2020 Junio | 42 | 25 | 67 |
| 2020 Mayo | 32 | 15 | 47 |
| 2020 Abril | 31 | 19 | 50 |
| 2020 Marzo | 33 | 23 | 56 |
| 2020 Febrero | 6 | 0 | 6 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Mayo | 2 | 1 | 3 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Febrero | 3 | 2 | 5 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 2 | 5 |
| 2018 Julio | 1 | 0 | 1 |
| 2018 Febrero | 7 | 2 | 9 |
| 2018 Enero | 17 | 10 | 27 |
| 2017 Diciembre | 17 | 9 | 26 |
| 2017 Noviembre | 23 | 9 | 32 |
| 2017 Octubre | 15 | 5 | 20 |
| 2017 Septiembre | 16 | 8 | 24 |
| 2017 Agosto | 14 | 12 | 26 |
| 2017 Julio | 21 | 7 | 28 |
| 2017 Junio | 26 | 21 | 47 |
| 2017 Mayo | 24 | 10 | 34 |
| 2017 Abril | 24 | 24 | 48 |
| 2017 Marzo | 20 | 25 | 45 |
| 2017 Febrero | 18 | 23 | 41 |
| 2017 Enero | 16 | 17 | 33 |
| 2016 Diciembre | 39 | 59 | 98 |
| 2016 Noviembre | 13 | 34 | 47 |
| 2016 Octubre | 0 | 15 | 15 |
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