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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction and Objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dactylitis or sausage finger is defined as inflammation of one or several fingers or toes&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Although any inflammatory process involving the digits could be considered dactylitis&#44; the term is reserved for a few well-defined entities&#46; It is considered one of the differential clinical features of spondyloarthropathies and&#44; in particular&#44; psoriatic arthritis&#46; However&#44; it can manifest during the course of diseases including gout&#44; sarcoidosis&#44; tuberculosis&#44; and syphilis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sarcoid dactylitis is a rare manifestation of sarcoidosis&#46; Most cases of sarcoid dactylitis are due to granulomatous involvement of the bone of the underlying phalanges&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> However&#44; subcutaneous sarcoidosis of the digits can give rise to a similar clinical presentation&#46; Below&#44; we report cases of subcutaneous sarcoidosis of the digits with a clinical presentation resembling dactylitis due to underlying bone involvement&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We reviewed diagnosed cases of subcutaneous sarcoidosis recorded in the database of specialized sarcoidosis consultations between 1988 and 2021 in a tertiary university hospital that provides care to approximately 1&#160;000&#160;000 people&#46; Clinical histories of the patients were reviewed and clinical images were examined to detect cases that presented lesions on the fingers&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">We identified 5 patients with subcutaneous sarcoidosis of the fingers over a period of 33 years&#58; 3 women and 2 men&#44; aged 45&#8211;75 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All patients consulted for their skin lesions&#46; Four patients had lesions predominantly on the forearms&#44; while in the remaining patient the lesions were limited to the fingers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The time since lesion appearance ranged from 3 to 24 months&#46; The lesions were not painful and persisted for 8&#8211;60 months in the 4 patients who were followed up until resolution &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">None of the patients had systemic symptoms at the time of diagnosis&#46; In all cases biopsy of the lesions revealed sarcoid granulomatous infiltration in the subcutaneous cellular tissue &#40;in the forearms in 3 cases and the fingers in 2 cases&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Extracutaneous lesions consisted of bilateral hilar adenopathies in 3 cases&#44; as revealed by chest radiography&#46; Conjunctival granulomas were detected in another case without intrathoracic involvement&#46; The remaining patient developed dactylitis lesions during the course of atezolizumab treatment for disseminated endometrial carcinoma&#44; but showed no signs of extracutaneous involvement&#46; Angiotensin converting enzyme &#40;ACE&#41; levels were elevated in 3 of the 4 cases in which they were determined&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dactylitis can be acute&#44; characterized by painful inflammation of the finger&#44; or can manifest as a chronic form&#44; which tends to be more persistent and less painful&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> The distinct forms of dactylitis also differ in terms of the affected tissue and the type of involvement&#46; The most frequent forms are dactylitis due to spondyloarthritis&#44; especially psoriatic arthritis&#44; which causes painful diffuse inflammation of the fingers and toes&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Studies using ultrasound and nuclear magnetic resonance have established that this form is due to tenosynovitis of the flexors&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Tenosynovitis that arises during the course of gout is also a common cause of dactylitis&#46; Pyogenic &#40;usually streptococcal&#41; infection of the soft parts of the finger also manifests as acute dactylitis&#46; Another less frequent form is tuberculous dactylitis&#44; which is caused by tuberculous osteomyelitis of the short tubular bones of the hands or feet&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Syphilitic dactylitis is a manifestation of congenital syphilis that is characterized by radiological findings similar to those of tuberculous dactylitis&#44; although the involvement is usually bilateral and symmetrical&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sarcoid dactylitis<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> is an uncommon manifestation of sarcoidosis that is seen in 0&#46;2&#37; of patients&#46; It is defined as the presence of swelling in the fingers or toes in patients with sarcoidosis&#44; mainly affecting the middle and&#44; less frequently&#44; distal phalanges&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;4</span></a> Radiologically&#44; sarcoid dactylitis is characterized by trabecular alterations with a honeycomb or lattice pattern&#44; which may or may not be associated with cystic formations and periosteal reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Histologically&#44; osseous lesions are characterized by noncaseating granulomas that invade the phalanges and surrounding soft tissue&#46; This form of sarcoid dactylitis due to granulomatous bone involvement is very persistent&#44; and is associated with lupus pernio and chronic forms of sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to sarcoid dactylitis due to granulomatous involvement of the bone of the underlying phalanges&#44; the term dactylitis has also been applied to patients with subcutaneous sarcoidosis affecting the fingers&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;8</span></a> These patients can exhibit a similar clinical presentation&#46; However&#44; in subcutaneous sarcoidosis the proximal phalanges are more frequently affected than the middle and distal phalanges&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> as in all our patients&#46; Another significant difference is that subcutaneous sarcoidosis of the fingers appears at the onset of the systemic disease&#44; and therefore its recognition can enable early diagnosis of systemic sarcoidosis&#44; avoiding the need for invasive examinations&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#8211;12</span></a> Because it is a form of subcutaneous sarcoidosis&#44; it could be assumed that it has similar prognostic significance regarding the course of systemic sarcoidosis&#46; Some studies have proposed that subcutaneous sarcoidosis is associated with acute forms of sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#8211;12</span></a> In agreement with those findings&#44; none of our patients developed complications typical of chronic sarcoidosis&#44; such as bone lesions or pulmonary fibrosis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 4 of our 5 patients&#44; dactylitis was associated with subcutaneous sarcoid lesions in other locations&#46; Therefore&#44; when sarcoid dactylitis is suspected&#44; the remaining extremities should be examined for subcutaneous nodular lesions&#44; especially the forearms&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> As in the case described by Curc&#243; et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> we did not detect underlying bone lesions in any of our patients&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment of sarcoid dactylitis due to underlying bone involvement usually requires high-dose oral corticosteroids combined with antimalarials and methotrexate&#44; or even the use of anti-TNF &#40;tumor necrosis factor&#41; drugs such as infliximab or adalimumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;14</span></a> In our patients&#44; digital lesions did not require specific treatment&#46; Two of our patients received systemic treatment&#44; indicated for extracutaneous involvement&#58; oral corticosteroids in one case and oral corticosteroids plus hydroxychloroquine in the other&#46; The digital lesions remained partially controlled until complete resolution &#40;after 60 and 36 months&#44; respectively&#41;&#46; In the remaining 2 patients for whom clinical follow-up data were available&#44; the digital lesions remitted spontaneously without requiring any treatment&#44; with a total lesion duration of 8 and 18 months&#44; respectively&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although the clinical appearance may be similar&#44; sarcoid dactylitis due to granulomatous infiltration of the underlying phalanges must be distinguished from sarcoid dactylitis due to subcutaneous involvement&#44; owing to the differences in clinical course and prognostic significance&#46; Ultrasound can be a fundamental tool for differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Dactylitis due to subcutaneous sarcoidosis is usually present at the onset of systemic sarcoidosis&#44; usually affects the proximal phalanges&#44; and is often accompanied by subcutaneous sarcoidosis in other locations&#44; especially the forearms&#46; It is necessary to rule out the presence of underlying bony lesions in cases of persistent dactylitis involving the middle and distal phalanges&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        1 => array:2 [
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          "titulo" => "Keywords"
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          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction and Objectives"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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          "identificador" => "sec0025"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1610381"
          "palabras" => array:4 [
            0 => "Dactylitis"
            1 => "Sarcoid dactylitis"
            2 => "Sarcoidosis"
            3 => "Subcutaneous sarcoidosis"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Dactilitis"
            1 => "Dactilitis sarcoidea"
            2 => "Sarcoidosis"
            3 => "Sarcoidosis subcut&#225;nea"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dactylitis&#44; or sausage fingers or toes&#44; refers to the swelling of 1 or more digits&#46; Sarcoid dactylitis is an uncommon form that tends to be caused by granulomatous bone involvement in the underlying phalanges&#46; Sarcoid dactylitis can&#44; however&#44; clinically resemble subcutaneous sarcoidosis with finger or toe involvement&#46; We describe 5 patients with dactylitis due to subcutaneous sarcoidosis of the fingers&#46; In all cases&#44; the proximal phalanges were involved&#59; sarcoid dactylitis&#44; by contrast&#44; tends to affect the medial and distal phalanges&#46; Differential diagnosis is important&#44; as dactylitis due to bone involvement tends to be much more persistent and is generally seen in chronic forms of sarcoidosis&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La dactilitis&#44; o dedo en salchicha&#44; se define como la inflamaci&#243;n de uno o varios dedos de las manos o de los pies&#46; La dactilitis sarcoidea es una forma poco frecuente de dactilitis que suele ser debida a la afectaci&#243;n &#243;sea granulomatosa a nivel de las falanges subyacentes&#46; Sin embargo&#44; una apariencia cl&#237;nica similar puede deberse a la presencia de una sarcoidosis subcut&#225;nea en los dedos&#46; Describimos 5 pacientes con dactilitis por una sarcoidosis subcut&#225;nea de los dedos&#46; En nuestros pacientes las lesiones se localizaron en las falanges proximales&#44; a diferencia de la dactilitis sarcoidea por afectaci&#243;n &#243;sea&#44; en la que suelen localizarse en las falanges medias y distales&#46; Es importante el diagn&#243;stico diferencial&#44; puesto que la dactilitis por afectaci&#243;n &#243;sea suele ser mucho m&#225;s persistente y asociarse a formas cr&#243;nicas de sarcoidosis&#46;</p></span>"
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        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#44; Case 1&#46; Dactylitis in the proximal phalanges of the first&#44; second&#44; and third fingers of the left hand&#46; B&#44; Case 2&#46; Dactylitis in the proximal phalanges of 3 fingers of each hand&#46; C&#44; Case 3&#46; Dactylitis in the proximal phalanges of the left middle finger and the right index finger&#46; D&#44; Case 4&#46; Dactylitis in the proximal phalanx of the right ring finger&#46; E&#44; Case 5&#46; Dactylitis in the proximal phalanges of the index&#44; middle&#44; and ring fingers of each hand&#46;</p>"
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          0 => array:3 [
            "identificador" => "at1"
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            "rol" => "short"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACE&#44; angiotensin-converting enzyme&#59; ECO&#44; echography&#59; F&#44; female&#59; M&#44; male&#46;</p>"
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            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">Case&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">Sex&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">Age&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">Time since onset&#44; mo&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">Duration&#44;mo&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">Dactylitis location&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">Other specific cutaneous sarcoidosis lesions&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">Radiological stage and extracutaneous involvement&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">ACE&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">Imaging studies&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">Treatment&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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&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">Proximal phalanges8 fingers&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">Subcutaneous&#44; forearmsScar on elbow&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">1Hilar and mediastinal adenopathies&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">&#8211;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Prednisone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&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">36&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">Proximal phalanges6 fingers&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">Subcutaneous&#44; forearms and kneesPapules on the kneesPlaques on the trunk&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">1Hilar lymphadenopathyHepatosplenic&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">0&#46;71 &#40;kat&#47;L&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;87&#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">ECO&#58; subcutaneous nodular lesions&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">PrednisoneHydroxychloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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">18&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">Proximal phalanges5 fingers&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">Subcutaneous&#44; forearms and legsPapules on knees&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">0Conjunctival&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">64<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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">Forearm radiograph without bone lesionsECO&#58; subcutaneous nodular lesions&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">No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&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="char" 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"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Proximal phalanxRight ring finger&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Subcutaneous&#44; forearms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1Hilar lymphadenopathyChoroidal granulomas&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">54<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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
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                  \t\t\t\t">ECO&#58; subcutaneous nodular lesions on fingers and forearms&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"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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">F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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&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">Proximal phalanges of fingers 2&#44; 3&#44; and 4 of each hand&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">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">No extracutaneous involvement detected<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">107<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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
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                  \t\t\t\t">Radiography of hands&#44; no bone lesionsECO&#58; subcutaneous nodular lesions on fingers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No treatment&nbsp;\t\t\t\t\t\t\n
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                  """
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                  "host" => array:1 [
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Brief Communication
Dactylitis Due to Subcutaneous Sarcoidosis as a Manifestation of Sarcoidosis
Dactilitis producida por sarcoidosis subcutánea como presentación de sarcoidosis
J. Marcoval
Autor para correspondencia
jmarcoval@bellvitgehospital.cat

Corresponding author.
, C. Llobera-Ris, C. Moreno-Vílchez, C. Torrecilla-Vall-Llossera, J. Sánchez Sánchez, J. Molinero Caturla
Servicio de Dermatología, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Most cases of sarcoid dactylitis are due to granulomatous involvement of the bone of the underlying phalanges&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> However&#44; subcutaneous sarcoidosis of the digits can give rise to a similar clinical presentation&#46; Below&#44; we report cases of subcutaneous sarcoidosis of the digits with a clinical presentation resembling dactylitis due to underlying bone involvement&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We reviewed diagnosed cases of subcutaneous sarcoidosis recorded in the database of specialized sarcoidosis consultations between 1988 and 2021 in a tertiary university hospital that provides care to approximately 1&#160;000&#160;000 people&#46; Clinical histories of the patients were reviewed and clinical images were examined to detect cases that presented lesions on the fingers&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">We identified 5 patients with subcutaneous sarcoidosis of the fingers over a period of 33 years&#58; 3 women and 2 men&#44; aged 45&#8211;75 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All patients consulted for their skin lesions&#46; Four patients had lesions predominantly on the forearms&#44; while in the remaining patient the lesions were limited to the fingers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The time since lesion appearance ranged from 3 to 24 months&#46; The lesions were not painful and persisted for 8&#8211;60 months in the 4 patients who were followed up until resolution &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">None of the patients had systemic symptoms at the time of diagnosis&#46; In all cases biopsy of the lesions revealed sarcoid granulomatous infiltration in the subcutaneous cellular tissue &#40;in the forearms in 3 cases and the fingers in 2 cases&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Extracutaneous lesions consisted of bilateral hilar adenopathies in 3 cases&#44; as revealed by chest radiography&#46; Conjunctival granulomas were detected in another case without intrathoracic involvement&#46; The remaining patient developed dactylitis lesions during the course of atezolizumab treatment for disseminated endometrial carcinoma&#44; but showed no signs of extracutaneous involvement&#46; Angiotensin converting enzyme &#40;ACE&#41; levels were elevated in 3 of the 4 cases in which they were determined&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dactylitis can be acute&#44; characterized by painful inflammation of the finger&#44; or can manifest as a chronic form&#44; which tends to be more persistent and less painful&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> The distinct forms of dactylitis also differ in terms of the affected tissue and the type of involvement&#46; The most frequent forms are dactylitis due to spondyloarthritis&#44; especially psoriatic arthritis&#44; which causes painful diffuse inflammation of the fingers and toes&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Studies using ultrasound and nuclear magnetic resonance have established that this form is due to tenosynovitis of the flexors&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Tenosynovitis that arises during the course of gout is also a common cause of dactylitis&#46; Pyogenic &#40;usually streptococcal&#41; infection of the soft parts of the finger also manifests as acute dactylitis&#46; Another less frequent form is tuberculous dactylitis&#44; which is caused by tuberculous osteomyelitis of the short tubular bones of the hands or feet&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> Syphilitic dactylitis is a manifestation of congenital syphilis that is characterized by radiological findings similar to those of tuberculous dactylitis&#44; although the involvement is usually bilateral and symmetrical&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sarcoid dactylitis<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> is an uncommon manifestation of sarcoidosis that is seen in 0&#46;2&#37; of patients&#46; It is defined as the presence of swelling in the fingers or toes in patients with sarcoidosis&#44; mainly affecting the middle and&#44; less frequently&#44; distal phalanges&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;4</span></a> Radiologically&#44; sarcoid dactylitis is characterized by trabecular alterations with a honeycomb or lattice pattern&#44; which may or may not be associated with cystic formations and periosteal reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> Histologically&#44; osseous lesions are characterized by noncaseating granulomas that invade the phalanges and surrounding soft tissue&#46; This form of sarcoid dactylitis due to granulomatous bone involvement is very persistent&#44; and is associated with lupus pernio and chronic forms of sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to sarcoid dactylitis due to granulomatous involvement of the bone of the underlying phalanges&#44; the term dactylitis has also been applied to patients with subcutaneous sarcoidosis affecting the fingers&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;8</span></a> These patients can exhibit a similar clinical presentation&#46; However&#44; in subcutaneous sarcoidosis the proximal phalanges are more frequently affected than the middle and distal phalanges&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> as in all our patients&#46; Another significant difference is that subcutaneous sarcoidosis of the fingers appears at the onset of the systemic disease&#44; and therefore its recognition can enable early diagnosis of systemic sarcoidosis&#44; avoiding the need for invasive examinations&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#8211;12</span></a> Because it is a form of subcutaneous sarcoidosis&#44; it could be assumed that it has similar prognostic significance regarding the course of systemic sarcoidosis&#46; Some studies have proposed that subcutaneous sarcoidosis is associated with acute forms of sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#8211;12</span></a> In agreement with those findings&#44; none of our patients developed complications typical of chronic sarcoidosis&#44; such as bone lesions or pulmonary fibrosis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 4 of our 5 patients&#44; dactylitis was associated with subcutaneous sarcoid lesions in other locations&#46; Therefore&#44; when sarcoid dactylitis is suspected&#44; the remaining extremities should be examined for subcutaneous nodular lesions&#44; especially the forearms&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> As in the case described by Curc&#243; et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> we did not detect underlying bone lesions in any of our patients&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment of sarcoid dactylitis due to underlying bone involvement usually requires high-dose oral corticosteroids combined with antimalarials and methotrexate&#44; or even the use of anti-TNF &#40;tumor necrosis factor&#41; drugs such as infliximab or adalimumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;14</span></a> In our patients&#44; digital lesions did not require specific treatment&#46; Two of our patients received systemic treatment&#44; indicated for extracutaneous involvement&#58; oral corticosteroids in one case and oral corticosteroids plus hydroxychloroquine in the other&#46; The digital lesions remained partially controlled until complete resolution &#40;after 60 and 36 months&#44; respectively&#41;&#46; In the remaining 2 patients for whom clinical follow-up data were available&#44; the digital lesions remitted spontaneously without requiring any treatment&#44; with a total lesion duration of 8 and 18 months&#44; respectively&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although the clinical appearance may be similar&#44; sarcoid dactylitis due to granulomatous infiltration of the underlying phalanges must be distinguished from sarcoid dactylitis due to subcutaneous involvement&#44; owing to the differences in clinical course and prognostic significance&#46; Ultrasound can be a fundamental tool for differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Dactylitis due to subcutaneous sarcoidosis is usually present at the onset of systemic sarcoidosis&#44; usually affects the proximal phalanges&#44; and is often accompanied by subcutaneous sarcoidosis in other locations&#44; especially the forearms&#46; It is necessary to rule out the presence of underlying bony lesions in cases of persistent dactylitis involving the middle and distal phalanges&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Introduction and Objectives"
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            0 => "Dactylitis"
            1 => "Sarcoid dactylitis"
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            3 => "Subcutaneous sarcoidosis"
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            0 => "Dactilitis"
            1 => "Dactilitis sarcoidea"
            2 => "Sarcoidosis"
            3 => "Sarcoidosis subcut&#225;nea"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dactylitis&#44; or sausage fingers or toes&#44; refers to the swelling of 1 or more digits&#46; Sarcoid dactylitis is an uncommon form that tends to be caused by granulomatous bone involvement in the underlying phalanges&#46; Sarcoid dactylitis can&#44; however&#44; clinically resemble subcutaneous sarcoidosis with finger or toe involvement&#46; We describe 5 patients with dactylitis due to subcutaneous sarcoidosis of the fingers&#46; In all cases&#44; the proximal phalanges were involved&#59; sarcoid dactylitis&#44; by contrast&#44; tends to affect the medial and distal phalanges&#46; Differential diagnosis is important&#44; as dactylitis due to bone involvement tends to be much more persistent and is generally seen in chronic forms of sarcoidosis&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La dactilitis&#44; o dedo en salchicha&#44; se define como la inflamaci&#243;n de uno o varios dedos de las manos o de los pies&#46; La dactilitis sarcoidea es una forma poco frecuente de dactilitis que suele ser debida a la afectaci&#243;n &#243;sea granulomatosa a nivel de las falanges subyacentes&#46; Sin embargo&#44; una apariencia cl&#237;nica similar puede deberse a la presencia de una sarcoidosis subcut&#225;nea en los dedos&#46; Describimos 5 pacientes con dactilitis por una sarcoidosis subcut&#225;nea de los dedos&#46; En nuestros pacientes las lesiones se localizaron en las falanges proximales&#44; a diferencia de la dactilitis sarcoidea por afectaci&#243;n &#243;sea&#44; en la que suelen localizarse en las falanges medias y distales&#46; Es importante el diagn&#243;stico diferencial&#44; puesto que la dactilitis por afectaci&#243;n &#243;sea suele ser mucho m&#225;s persistente y asociarse a formas cr&#243;nicas de sarcoidosis&#46;</p></span>"
      ]
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#44; Case 1&#46; Dactylitis in the proximal phalanges of the first&#44; second&#44; and third fingers of the left hand&#46; B&#44; Case 2&#46; Dactylitis in the proximal phalanges of 3 fingers of each hand&#46; C&#44; Case 3&#46; Dactylitis in the proximal phalanges of the left middle finger and the right index finger&#46; D&#44; Case 4&#46; Dactylitis in the proximal phalanx of the right ring finger&#46; E&#44; Case 5&#46; Dactylitis in the proximal phalanges of the index&#44; middle&#44; and ring fingers of each hand&#46;</p>"
        ]
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACE&#44; angiotensin-converting enzyme&#59; ECO&#44; echography&#59; F&#44; female&#59; M&#44; male&#46;</p>"
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                  <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">Case&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">Sex&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">Age&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">Time since onset&#44; mo&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">Duration&#44;mo&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">Dactylitis location&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">Other specific cutaneous sarcoidosis lesions&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">Radiological stage and extracutaneous involvement&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">ACE&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">Imaging studies&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">Treatment&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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&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">Proximal phalanges8 fingers&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">Subcutaneous&#44; forearmsScar on elbow&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">1Hilar and mediastinal adenopathies&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">&#8211;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Prednisone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&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">36&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">Proximal phalanges6 fingers&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">Subcutaneous&#44; forearms and kneesPapules on the kneesPlaques on the trunk&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">1Hilar lymphadenopathyHepatosplenic&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">0&#46;71 &#40;kat&#47;L&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;87&#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">ECO&#58; subcutaneous nodular lesions&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">PrednisoneHydroxychloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&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">18&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">Proximal phalanges5 fingers&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">Subcutaneous&#44; forearms and legsPapules on knees&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">0Conjunctival&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">64<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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">Forearm radiograph without bone lesionsECO&#58; subcutaneous nodular lesions&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">No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&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="char" 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"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">Proximal phalanxRight ring finger&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">Subcutaneous&#44; forearms&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">1Hilar lymphadenopathyChoroidal granulomas&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">54<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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">ECO&#58; subcutaneous nodular lesions on fingers and forearms&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"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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">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="char" 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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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&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">Proximal phalanges of fingers 2&#44; 3&#44; and 4 of each hand&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">&#8211;&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">No extracutaneous involvement detected<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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">107<span class="elsevierStyleHsp" style=""></span>U&#47;L &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>52&#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">Radiography of hands&#44; no bone lesionsECO&#58; subcutaneous nodular lesions on fingers&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">No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Case 4&#58; lost to follow-up due to change of address&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of the Patients&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Olivieri"
                            1 => "E&#46; Scarano"
                            2 => "A&#46; Padula"
                            3 => "V&#46; Giasi"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/03009740600906677"
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                        "link" => array:1 [
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                            "web" => "Medline"
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            1 => array:3 [
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                    0 => array:2 [
                      "titulo" => "Dactilitis&#58; evaluaci&#243;n&#44; implicaciones pron&#243;sticas y abordaje terap&#233;utico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:7 [
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                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dactilitis granulomatosa como manifestaci&#243;n inusual de la sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Garc&#237;a-Morales"
                            1 => "E&#46; S&#225;nchez Garc&#237;a"
                            2 => "A&#46; Crespo Cruz"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
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            ]
            3 => array:3 [
              "identificador" => "bib0095"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dactylitis in sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Mori"
                            1 => "T&#46; Yamamoto"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lytic lesion involving the first phalanx&#58; sarcoidosis should be suspected"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z&#46; Alaya"
                            1 => "A&#46; Mzabi"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.11604/pamj.2017.26.210.12076"
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                        "tituloSerie" => "Pan Afr Med J"
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                        "paginaInicial" => "210"
                        "link" => array:1 [
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            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "P&#46; Pitt"
                            1 => "E&#46;B&#46; Hamilton"
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                            3 => "K&#46;D&#46; Morley"
                            4 => "B&#46;E&#46; Monk"
                            5 => "G&#46;R&#46; Hughes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.42.6.634"
                      "Revista" => array:6 [
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            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subcutaneous sarcoidosis with dactylitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Curco"
                            1 => "X&#46; Pagerols"
                            2 => "P&#46; Vives"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                ]
              ]
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            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subcutaneous sarcoidosis with dactylitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "&#193;&#46; Gonz&#225;lez-Cantero"
                            1 => "A&#46;I&#46; S&#225;nchez-Moya"
                            2 => "E&#46; Mart&#237;nez-Lorenzo"
                            3 => "C&#46; P&#233;rez-Hortet"
                            4 => "C&#46; Schoendorff-Ortega"
                          ]
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