Case and Research Letter
Atypical Paraneoplastic Pemphigus Without Mucosal Involvement
Pénfigo paraneoplásico atípico sin compromiso mucoso
Leído
3716
Vecesse ha leído el artículo
1187
Total PDF
2529
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S0001731022002782" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.04.001" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "2992" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:T519-T521" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0001731021003161" "issn" => "00017310" "doi" => "10.1016/j.ad.2020.05.018" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "2749" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:522-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Ecografía de acropaquia digital" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "522" "paginaFinal" => "523" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Digital Clubbing: Ultrasound Findings" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 799 "Ancho" => 2105 "Tamanyo" => 165340 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a. Uña normal, ángulo de Lovibond menor de 160°. b. Acropaquia digital.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Fernandez-Quiroga, F. Alfageme-Roldán, G. Roustan-Gullón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Fernandez-Quiroga" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme-Roldán" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Roustan-Gullón" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003161?idApp=UINPBA000044" "url" => "/00017310/0000011300000005/v1_202206110542/S0001731021003161/v1_202206110542/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0001731021004300" "issn" => "00017310" "doi" => "10.1016/j.ad.2020.08.029" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "2820" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:519-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Pénfigo paraneoplásico atípico sin compromiso mucoso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "521" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atypical Paraneoplastic Pemphigus Without Mucosal Involvement" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 663 "Ancho" => 950 "Tamanyo" => 101224 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Manifestaciones clínicas: erosiones múltiples presentes en tronco, brazos, cuello, nalgas y muslos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Ferreira, Á. Machado, M. Sanches, M. Selores" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Machado" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Sanches" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Selores" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021004300?idApp=UINPBA000044" "url" => "/00017310/0000011300000005/v1_202206110542/S0001731021004300/v1_202206110542/es/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0001731021004300" "issn" => "00017310" "doi" => "10.1016/j.ad.2020.08.029" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "2820" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:519-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Pénfigo paraneoplásico atípico sin compromiso mucoso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "521" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atypical Paraneoplastic Pemphigus Without Mucosal Involvement" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 663 "Ancho" => 950 "Tamanyo" => 101224 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Manifestaciones clínicas: erosiones múltiples presentes en tronco, brazos, cuello, nalgas y muslos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Ferreira, Á. Machado, M. Sanches, M. Selores" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Machado" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Sanches" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Selores" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021004300?idApp=UINPBA000044" "url" => "/00017310/0000011300000005/v1_202206110542/S0001731021004300/v1_202206110542/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => " Atypical Paraneoplastic Pemphigus Without Mucosal Involvement" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T519" "paginaFinal" => "T521" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Ferreira, Á. Machado, M. Sanches, M. Selores" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Ferreira" "email" => array:1 [ 0 => "mf.sandraferreira@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Á." "apellidos" => "Machado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Sanches" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Selores" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pénfigo paraneoplásico atípico sin compromiso mucoso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2500 "Ancho" => 2500 "Tamanyo" => 585537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Mamography showing a tumor on the right breast. (B) Histopathology showing vesicle formation with areas of subepidermal cleft formation, suprabasilar acantholysis and necrotic keratinocytes (hematoxylin and eosin [H&E]; original magnification ×200). (C) Direct immunofluorescence of perilesional skin demonstrating intercellular immunoglobulin G staining. (D) Indirect immunofluorescence demonstrating circulating immunoglobulin G antibodies binding to rat bladder epithelium.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paraneoplastic pemphigus (PNP) is a rare and often fatal autoimmune mucocutaneous blistering disease that is associated with an underlying malignancy, particularly lymphoproliferative diseases. Several clinical morphologic variants of PNP have described, with the most consistent finding being severe stomatitis. Treatment of PNP is difficult and prognosis is poor.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a case of a 79-year-old woman, with no relevant personal history, presenting with a 12-month history of pruritus and a flaccid vesiculobullous eruption. Skin examination revealed several erosions and crusts, on the trunk, arms, thighs and neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no involvement of the mucous membranes (oral, conjunctival or anogenital). Additionally, a hard mass with 17<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mm in diameter, on the right breast, was noted on physical examination.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A mammography demonstrated a tumor on the right breast, which was subsequently confirmed histologically as an invasive carcinoma of no special type (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Skin biopsy revealed suprabasal acantholysis and necrotic keratinocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Direct immunofluorescence (DIF) of perilesional skin demonstrated intercellular immunoglobulin G (IgG) deposits (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Indirect immunofluorescence (IIF) on rat bladder demonstrated IgG anticell surface antibodies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). Enzyme-linked immunosorbent assay (ELISA) also detected antibodies to envoplakin, and desmogleins (Dsg) 1 and 3. These results were consistent with the diagnosis of PNP.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Skin lesions were treated with clobetasol propionate 0.05% cream with significant clinical improvement, although with cyclic relapses. The patient was referred to the Hospital's Breast Unit and started neoadjuvant hormonotherapy with anastrozole 1<span class="elsevierStyleHsp" style=""></span>mg once daily. There was a good response to anastrazole, with complete resolution of skin lesions and pruritus. She refused surgical treatment and has remained lesion free for 18 months with hormonotherapy. Tumor size has also gradually reduced over time.</p><p id="par0025" class="elsevierStylePara elsevierViewall">PNP most frequent clinical feature is severe erosive stomatitis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Mucosal involvement was absent in our patient, however the presence of polymorphic cutaneous lesions, in association with the results from immunofluorescence, the detection of antibodies anti-envoplakin in the patient's serum, and the concurrent breast cancer, strongly favor this diagnosis. In particular, the detection of antibodies to envoplakin is highly sensitive and specific for PNP.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The present case represents a striking and unique form of PNP due to the absence of mucosal involvement. To our knowledge, only 2 cases have been described in the literature, one was associated with thymoma and myasthenia gravis and the other with endometrial carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> The underlying cause of the absence of mucosal involvement in our patient remains unknown. Antibodies anti-Dsg 3 are thought to be important in the pathogenesis of mucosal lesions in PNP, but mucosal involvement may be seen even in those cases that are negative for anti-Dsg 3. Nevertheless, mucous membranes were spared in our patient, although circulating antibodies anti-Dsg 3 were detected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Interestingly, PNP was induced by a breast carcinoma, which is also not common. The majority of cases of PNP are associated with hematologic malignancies, particularly non-Hodgkin lymphoma, chronic lymphocytic leukemia and Castleman's disease, however non-hematologic malignancies may occur in up to 16 percent of all cases.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis of PNP is based not only on clinical features, but also histological and immunofluorescence findings. Histological findings in PNP are variable, often resembling other disorders with similar clinical features, thus diagnosis may a true challenge.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> However, the presence of suprabasal acantholysis and keratinocytes necrosis, as observed in this patient, is a common feature. Other diagnostic criteria for PNP include DIF examination revealing cell surface and, occasionally, basement membrane zone deposits; IIF showing positive staining of rat bladder epithelium; and detection of antibodies to various proteins of the plakin gene family and Dsg 1 and Dsg 3.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,7,8</span></a> Of note, IIF is particularly useful for distinguish PNP from pemphigus vulgaris, with the latter only binding with stratified epithelium of monkey esophagus and presenting negative staining with rat bladder epithelium.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Noteworthy, the response to treatment was better than that seen in many cases of PNP, so perhaps, this atypical presentation of PNP may be associated to a better prognosis. Further studies and follow-up are necessary to understand and elucidate the clinical importance and prognostic significance of these new findings.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, the case of PNP present herein is unusual and unique for the absence of mucosal involvement and its association with breast cancer, and demonstrates the complexity and polymorphism of this immunobullous disease. Therefore, it is essential to recognize the importance of the correlation of clinicopathological and immunological findings in PNP and the possibility of occurring atypical presentations that should prompt immunopathologic confirmation and evaluation for an occult neoplasm.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</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" => 1111 "Ancho" => 1583 "Tamanyo" => 210829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical manifestations: multiple erosions present on the trunk, arms, neck, buttocks and thighs.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2500 "Ancho" => 2500 "Tamanyo" => 585537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Mamography showing a tumor on the right breast. (B) Histopathology showing vesicle formation with areas of subepidermal cleft formation, suprabasilar acantholysis and necrotic keratinocytes (hematoxylin and eosin [H&E]; original magnification ×200). (C) Direct immunofluorescence of perilesional skin demonstrating intercellular immunoglobulin G staining. (D) Indirect immunofluorescence demonstrating circulating immunoglobulin G antibodies binding to rat bladder epithelium.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and immunological findings in 104 cases of paraneoplastic pemphigus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ohzono" 1 => "R. Sogame" 2 => "X. Li" 3 => "K. Teye" 4 => "A. Tsuchisaka" 5 => "S. Numata" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2015" "volumen" => "173" "paginaInicial" => "1447" "paginaFinal" => "1952" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitivity and specificity of clinical, histologic, and immunologic features in the diagnosis of paraneoplastic pemphigus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Joly" 1 => "C. Richard" 2 => "D. Gilbert" 3 => "P. Courville" 4 => "O. Chosidow" 5 => "J.C. Roujeau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.107488" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "619" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11004616" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "No mucosal involvement in a patient with paraneoplastic pemphigus associated with thymoma and myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.E. Lee" 1 => "T. Hashimoto" 2 => "S.C. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08763.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2008" "volumen" => "159" "paginaInicial" => "986" "paginaFinal" => "988" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18644017" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022202X19325369" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical paraneoplastic pemphigus secondary to endometrial carcinoma with no mucosal involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.A. Kennedy" 1 => "S. Dawe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2230.2008.03150.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "e130" "paginaFinal" => "e133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19438579" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic pemphigus: an autoimmune mucocutaneous disease associated with neoplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Anhalt" 1 => "S.C. Kim" 2 => "J.R. Stanley" 3 => "N.J. Korman" 4 => "D.A. Jabs" 5 => "M. Kory" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199012203232503" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1990" "volumen" => "323" "paginaInicial" => "1729" "paginaFinal" => "1735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2247105" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neoplasms associated with paraneoplastic pemphigus: a review with emphasis on non-hematologic malignancy and oral mucosal manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Kaplan" 1 => "E. Hodak" 2 => "L. Ackerman" 3 => "D. Mimouni" 4 => "G.J. Anhalt" 5 => "S. Calderon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oraloncology.2003.09.020" "Revista" => array:6 [ "tituloSerie" => "Oral Oncol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "553" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15063382" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histologic features of paraneoplastic pemphigus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.D. Horn" 1 => "G.J. Anhalt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1992" "volumen" => "128" "paginaInicial" => "1091" "paginaFinal" => "1095" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1497365" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A nonfatal case and 2 fatal cases of paraneoplastic pemphigus: can a complement indirect immunofluorescent test help to identify fatal “group A” paraneoplastic pemphigus cases?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.H. Beutner" 1 => "S. Pelton" 2 => "T. Hashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2002.123486" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2002" "volumen" => "47" "paginaInicial" => "841" "paginaFinal" => "851" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12451367" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct and indirect immunofluorescence for the diagnosis of bullous autoimmune diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Pohla-Gubo" 1 => "H. Hintner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "365" "paginaFinal" => "372" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000005/v1_202206110542/S0001731022002782/v1_202206110542/en/main.assets" "Apartado" => array:4 [ "identificador" => "92870" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas / Case and Research Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000005/v1_202206110542/S0001731022002782/v1_202206110542/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022002782?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 6 | 12 |
| 2024 Octubre | 120 | 52 | 172 |
| 2024 Septiembre | 117 | 34 | 151 |
| 2024 Agosto | 126 | 63 | 189 |
| 2024 Julio | 89 | 46 | 135 |
| 2024 Junio | 101 | 51 | 152 |
| 2024 Mayo | 91 | 53 | 144 |
| 2024 Abril | 88 | 28 | 116 |
| 2024 Marzo | 91 | 46 | 137 |
| 2024 Febrero | 71 | 31 | 102 |
| 2024 Enero | 65 | 34 | 99 |
| 2023 Diciembre | 52 | 13 | 65 |
| 2023 Noviembre | 93 | 34 | 127 |
| 2023 Octubre | 69 | 23 | 92 |
| 2023 Septiembre | 75 | 31 | 106 |
| 2023 Agosto | 56 | 18 | 74 |
| 2023 Julio | 93 | 22 | 115 |
| 2023 Junio | 68 | 18 | 86 |
| 2023 Mayo | 77 | 21 | 98 |
| 2023 Abril | 62 | 19 | 81 |
| 2023 Marzo | 93 | 33 | 126 |
| 2023 Febrero | 53 | 34 | 87 |
| 2023 Enero | 77 | 54 | 131 |
| 2022 Diciembre | 70 | 49 | 119 |
| 2022 Noviembre | 71 | 48 | 119 |
| 2022 Octubre | 65 | 35 | 100 |
| 2022 Septiembre | 60 | 48 | 108 |
| 2022 Agosto | 83 | 56 | 139 |
| 2022 Julio | 86 | 40 | 126 |
| 2022 Junio | 119 | 53 | 172 |
| 2022 Mayo | 127 | 56 | 183 |
| 2022 Abril | 15 | 38 | 53 |
Mostrar todo
