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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La dermatomiositis &#40;DM&#41; cursa con diversas manifestaciones cut&#225;neas&#44; algunas de las cuales est&#225;n asociadas a neoplasias internas&#46; Hasta la fecha&#44; se han reportado informes de casos individuales de DM ves&#237;culo-ampollosa en la literatura inglesa<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1-6</span></a>&#46; Describimos aqu&#237; cinco casos de DM ves&#237;culo-ampollosa en pacientes con neoplasias internas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El presente estudio incluy&#243; cinco pacientes con DM&#44; que desarrollaron ves&#237;culas y&#47;o ampollas durante su curso&#46; El diagn&#243;stico de DM se bas&#243; en los criterios diagn&#243;sticos propuestos por Bohan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; El diagn&#243;stico de DM cl&#237;nicamente amiop&#225;tica se realiz&#243; sobre la base de los criterios de clasificaci&#243;n propuestos por Sontheimer<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Los pacientes fueron cuatro varones y una mujer&#44; con un rango de edad de 68 a 76<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;edad media&#58; 71&#44;6<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La localizaci&#243;n de la lesi&#243;n ampollosa fue la siguiente&#58; codo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; parte superior del brazo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; rodilla &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tronco &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y hombro &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se realiz&#243; biopsia de la lesi&#243;n ampollosa en cuatro casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1 a<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; que revel&#243; edema subepid&#233;rmico marcado con dep&#243;sito de mucina en la dermis superior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los hallazgos de inmunofluorescencia directa fueron negativos en la zona de membrana basal en todos los casos&#46; Otros signos cut&#225;neos observados fueron p&#225;pulas de Gottron &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; poiquilodermia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; eritema maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; eritema facial de tipo dermatitis seborreica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y eritema flagelado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1&#44; 3 y<span class="elsevierStyleHsp" style=""></span>5&#41; estuvieron acompa&#241;ados de miositis&#44; y un caso &#40;caso<span class="elsevierStyleHsp" style=""></span>4&#41; fue diagnosticado de DM cl&#237;nicamente amiop&#225;tica&#46; En un solo caso &#40;caso<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; se detectaron autoanticuerpos espec&#237;ficos de miositis&#44; es decir&#44; anticuerpos anti-TIF-1&#947;&#46; No se observ&#243; enfermedad pulmonar intersticial &#40;EPI&#41; en ninguno de los casos&#46; Se observaron neoplasias en todos los casos&#58; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer de es&#243;fago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>2&#44; 4 y<span class="elsevierStyleHsp" style=""></span>5&#41; fueron tratados con quimioterapia&#46; En el caso<span class="elsevierStyleHsp" style=""></span>1 se diagnostic&#243; c&#225;ncer de es&#243;fago tras el alta de nuestro hospital&#44; no siendo clara la situaci&#243;n m&#233;dica detallada del paciente&#46; En el caso<span class="elsevierStyleHsp" style=""></span>3 existieron muchas lesiones metast&#225;sicas en el momento del diagn&#243;stico de c&#225;ncer de ovario&#44; no pudiendo tratarse a la paciente con quimioterapia debido a su mala situaci&#243;n general&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1&#44; 3 y<span class="elsevierStyleHsp" style=""></span>4&#41; fueron tratados con prednisolona oral&#46; El paciente del caso<span class="elsevierStyleHsp" style=""></span>1 tuvo disfagia progresiva y severa&#44; siendo tratado con metilprednisolona &#40;1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;diarios durante tres d&#237;as consecutivos&#41;&#44; terapia de inmunoglobulina intravenosa en tres tiempos&#44; prednisolona y metotrexato&#46; Sin embargo&#44; la funci&#243;n deglutoria no se recuper&#243; totalmente y el paciente desarroll&#243; neumon&#237;a por aspiraci&#243;n repetidamente&#46; Tres pacientes &#40;casos<span class="elsevierStyleHsp" style=""></span>3 a<span class="elsevierStyleHsp" style=""></span>5&#41; murieron debido a las neoplasias transcurridos 6<span class="elsevierStyleHsp" style=""></span>meses&#44; 1<span class="elsevierStyleHsp" style=""></span>a&#241;o y 2<span class="elsevierStyleHsp" style=""></span>a&#241;os del diagn&#243;stico de DM&#44; respectivamente&#46; Se desconoci&#243; el pron&#243;stico de los dos casos restantes &#40;casos<span class="elsevierStyleHsp" style=""></span>1 y<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; En todos los casos&#44; las lesiones ampollosas aparecieron paralelamente al inicio o el incremento de la actividad de DM&#44; que fue diagnosticada m&#225;s o menos al mismo tiempo de descubrirse el c&#225;ncer o el desarrollo de met&#225;stasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La formaci&#243;n de ves&#237;culas en la DM es relativamente rara&#44; aunque est&#225; altamente asociada a la neoplasia interna&#46; Todos nuestros pacientes ten&#237;an c&#225;nceres s&#243;lidos&#44; es decir&#44; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer de es&#243;fago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Se excluy&#243; la erupci&#243;n ampollosa inducida por f&#225;rmacos&#46; De acuerdo con el informe de Kubo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; se revisaron 19 casos de DM ves&#237;culo-ampollosa&#44; de los cuales 6 casos fueron varones y 13 casos fueron mujeres&#46; Se observ&#243; neoplasia interna en 10 casos&#58; en ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; cuello uterino &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; est&#243;mago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; trompa uterina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; gl&#225;ndula mamaria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tras su informe&#44; recopilamos 17 casos de DM ves&#237;culo-bullosa&#44; incluyendo aquellos con c&#225;ncer de mama &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer nasofar&#237;ngeo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; linfoma maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de colon &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de est&#243;mago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de tiroides &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Sin embargo&#44; no existi&#243; neoplasia en 6 casos&#44; y se observ&#243; EPI en 4 casos&#46; La incidencia de neoplasia interna fue muy superior en los pacientes con DM ves&#237;culo-ampollosa&#44; en comparaci&#243;n con aquellos sin lesiones ampollosas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se examinaron los anticuerpos espec&#237;ficos de miositis en muy pocos de nuestros casos&#44; dado que el examen de dichos anticuerpos ha estado disponible muy recientemente&#46; Los anticuerpos anti-TIF-1&#947; se examinaron en un caso &#40;caso<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; que reflej&#243; t&#237;tulos positivos&#46; La prevalencia del c&#225;ncer en los pacientes con positividad anti-TIF-1&#947; var&#237;a entre el 38 y el 80&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Un informe reciente sugiere que el cambio inusual de los ant&#237;genos tumorales puede desencadenar una respuesta autoinmune mediante inmunidad de reacci&#243;n cruzada&#44; causando da&#241;o muscular<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; se desconoce el mecanismo de inducci&#243;n de la formaci&#243;n vesicular asociado a ant&#237;genos tumorales&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en una DM la lesi&#243;n ves&#237;culo-ampollosa es un signo cut&#225;neo paraneopl&#225;sico de neoplasia interna&#44; 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        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aspectos ves&#237;culo-ampollosos &#40;a&#58; caso 4&#59; b&#58; caso 2&#59; c&#58; caso 5&#59; d&#58; caso 1&#41;&#46; gr1&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 384
            "Ancho" => 1005
            "Tamanyo" => 102364
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histolog&#237;a que refleja ampollas subepid&#233;rmicas &#40;a&#58; tinci&#243;n H-E&#41;&#46; Dep&#243;sito de mucina bajo la ampolla &#40;b&#58; tinci&#243;n de hierro coloidal&#41;&#46; gr2&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CK&#58; creatincinasa&#59; IVIG&#58; inmunoglobulina intravenosa&#59; mPSL&#58; metilprednisolona&#59; MTX&#58; metotrexato&#59; PSL&#58; prednisolona&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sitio de la lesi&#243;n ampollosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Otras lesiones cut&#225;neas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Enfermedad pulmonar intersticial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Miositis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CK &#40;U&#47;l&#41;45-163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ANA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Codo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&#44; dermatitis seborreica&#44; sangrado en pliegue ungueal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Es&#243;fago&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">320 &#40;homog&#233;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mPSL&#44; PSL&#44; IVIG&#44; MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parte superior del brazo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulm&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sin datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">462&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160 &#40;homog&#233;neo y moteado&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quimioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; eritema maligno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ovario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;homog&#233;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Codo&#44; hombro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eritema flagelado&#44; eritema maligno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulm&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&#44; Quimioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulm&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 160&nbsp;\t\t\t\t\t\t\n
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Carta científico-clínica
Dermatomiositis vesículo-ampollosa asociada a neoplasia interna
Vesiculo-Bullous Dermatomyositis in Association with Internal Malignancy
T. Mori
Autor para correspondencia
mtatsu@fmu.ac.jp

Autor para correspondencia.
, Y. Hanami, T. Yamamoto
Department of Dermatology, Fukushima Medical University, Fukushima, Japón
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La dermatomiositis &#40;DM&#41; cursa con diversas manifestaciones cut&#225;neas&#44; algunas de las cuales est&#225;n asociadas a neoplasias internas&#46; Hasta la fecha&#44; se han reportado informes de casos individuales de DM ves&#237;culo-ampollosa en la literatura inglesa<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1-6</span></a>&#46; Describimos aqu&#237; cinco casos de DM ves&#237;culo-ampollosa en pacientes con neoplasias internas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El presente estudio incluy&#243; cinco pacientes con DM&#44; que desarrollaron ves&#237;culas y&#47;o ampollas durante su curso&#46; El diagn&#243;stico de DM se bas&#243; en los criterios diagn&#243;sticos propuestos por Bohan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; El diagn&#243;stico de DM cl&#237;nicamente amiop&#225;tica se realiz&#243; sobre la base de los criterios de clasificaci&#243;n propuestos por Sontheimer<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Los pacientes fueron cuatro varones y una mujer&#44; con un rango de edad de 68 a 76<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;edad media&#58; 71&#44;6<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La localizaci&#243;n de la lesi&#243;n ampollosa fue la siguiente&#58; codo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; parte superior del brazo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; rodilla &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tronco &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y hombro &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se realiz&#243; biopsia de la lesi&#243;n ampollosa en cuatro casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1 a<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; que revel&#243; edema subepid&#233;rmico marcado con dep&#243;sito de mucina en la dermis superior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los hallazgos de inmunofluorescencia directa fueron negativos en la zona de membrana basal en todos los casos&#46; Otros signos cut&#225;neos observados fueron p&#225;pulas de Gottron &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; poiquilodermia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; eritema maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; eritema facial de tipo dermatitis seborreica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y eritema flagelado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1&#44; 3 y<span class="elsevierStyleHsp" style=""></span>5&#41; estuvieron acompa&#241;ados de miositis&#44; y un caso &#40;caso<span class="elsevierStyleHsp" style=""></span>4&#41; fue diagnosticado de DM cl&#237;nicamente amiop&#225;tica&#46; En un solo caso &#40;caso<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; se detectaron autoanticuerpos espec&#237;ficos de miositis&#44; es decir&#44; anticuerpos anti-TIF-1&#947;&#46; No se observ&#243; enfermedad pulmonar intersticial &#40;EPI&#41; en ninguno de los casos&#46; Se observaron neoplasias en todos los casos&#58; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer de es&#243;fago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>2&#44; 4 y<span class="elsevierStyleHsp" style=""></span>5&#41; fueron tratados con quimioterapia&#46; En el caso<span class="elsevierStyleHsp" style=""></span>1 se diagnostic&#243; c&#225;ncer de es&#243;fago tras el alta de nuestro hospital&#44; no siendo clara la situaci&#243;n m&#233;dica detallada del paciente&#46; En el caso<span class="elsevierStyleHsp" style=""></span>3 existieron muchas lesiones metast&#225;sicas en el momento del diagn&#243;stico de c&#225;ncer de ovario&#44; no pudiendo tratarse a la paciente con quimioterapia debido a su mala situaci&#243;n general&#46; Tres casos &#40;casos<span class="elsevierStyleHsp" style=""></span>1&#44; 3 y<span class="elsevierStyleHsp" style=""></span>4&#41; fueron tratados con prednisolona oral&#46; El paciente del caso<span class="elsevierStyleHsp" style=""></span>1 tuvo disfagia progresiva y severa&#44; siendo tratado con metilprednisolona &#40;1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#47;diarios durante tres d&#237;as consecutivos&#41;&#44; terapia de inmunoglobulina intravenosa en tres tiempos&#44; prednisolona y metotrexato&#46; Sin embargo&#44; la funci&#243;n deglutoria no se recuper&#243; totalmente y el paciente desarroll&#243; neumon&#237;a por aspiraci&#243;n repetidamente&#46; Tres pacientes &#40;casos<span class="elsevierStyleHsp" style=""></span>3 a<span class="elsevierStyleHsp" style=""></span>5&#41; murieron debido a las neoplasias transcurridos 6<span class="elsevierStyleHsp" style=""></span>meses&#44; 1<span class="elsevierStyleHsp" style=""></span>a&#241;o y 2<span class="elsevierStyleHsp" style=""></span>a&#241;os del diagn&#243;stico de DM&#44; respectivamente&#46; Se desconoci&#243; el pron&#243;stico de los dos casos restantes &#40;casos<span class="elsevierStyleHsp" style=""></span>1 y<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; En todos los casos&#44; las lesiones ampollosas aparecieron paralelamente al inicio o el incremento de la actividad de DM&#44; que fue diagnosticada m&#225;s o menos al mismo tiempo de descubrirse el c&#225;ncer o el desarrollo de met&#225;stasis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La formaci&#243;n de ves&#237;culas en la DM es relativamente rara&#44; aunque est&#225; altamente asociada a la neoplasia interna&#46; Todos nuestros pacientes ten&#237;an c&#225;nceres s&#243;lidos&#44; es decir&#44; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer de es&#243;fago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Se excluy&#243; la erupci&#243;n ampollosa inducida por f&#225;rmacos&#46; De acuerdo con el informe de Kubo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; se revisaron 19 casos de DM ves&#237;culo-ampollosa&#44; de los cuales 6 casos fueron varones y 13 casos fueron mujeres&#46; Se observ&#243; neoplasia interna en 10 casos&#58; en ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; cuello uterino &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; est&#243;mago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; trompa uterina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; gl&#225;ndula mamaria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Tras su informe&#44; recopilamos 17 casos de DM ves&#237;culo-bullosa&#44; incluyendo aquellos con c&#225;ncer de mama &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; c&#225;ncer nasofar&#237;ngeo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; c&#225;ncer de ovario &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de pulm&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; linfoma maligno &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de colon &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; c&#225;ncer de est&#243;mago &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y c&#225;ncer de tiroides &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; Sin embargo&#44; no existi&#243; neoplasia en 6 casos&#44; y se observ&#243; EPI en 4 casos&#46; La incidencia de neoplasia interna fue muy superior en los pacientes con DM ves&#237;culo-ampollosa&#44; en comparaci&#243;n con aquellos sin lesiones ampollosas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se examinaron los anticuerpos espec&#237;ficos de miositis en muy pocos de nuestros casos&#44; dado que el examen de dichos anticuerpos ha estado disponible muy recientemente&#46; Los anticuerpos anti-TIF-1&#947; se examinaron en un caso &#40;caso<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; que reflej&#243; t&#237;tulos positivos&#46; La prevalencia del c&#225;ncer en los pacientes con positividad anti-TIF-1&#947; var&#237;a entre el 38 y el 80&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Un informe reciente sugiere que el cambio inusual de los ant&#237;genos tumorales puede desencadenar una respuesta autoinmune mediante inmunidad de reacci&#243;n cruzada&#44; causando da&#241;o muscular<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; se desconoce el mecanismo de inducci&#243;n de la formaci&#243;n vesicular asociado a ant&#237;genos tumorales&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en una DM la lesi&#243;n ves&#237;culo-ampollosa es un signo cut&#225;neo paraneopl&#225;sico de neoplasia interna&#44; y no de EPI&#46; Los facultativos deber&#225;n tener en cuenta la DM ves&#237;culo-ampollosa&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los autores declaran la ausencia de conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&#44; dermatitis seborreica&#44; sangrado en pliegue ungueal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">320 &#40;homog&#233;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mPSL&#44; PSL&#44; IVIG&#44; MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parte superior del brazo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulm&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sin datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">462&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">160 &#40;homog&#233;neo y moteado&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quimioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; eritema maligno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ovario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;homog&#233;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Codo&#44; hombro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eritema flagelado&#44; eritema maligno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Pulm&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PSL&#44; Quimioterapia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Rodilla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;pulas de Gottron&#44; poiquilodermia&nbsp;\t\t\t\t\t\t\n
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                  """
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cinco pacientes con presentaci&#243;n de dermatomiositis ves&#237;culo-ampollosa</p>"
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ISSN: 00017310
Idioma original: Español
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