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Estudio PSEDA" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2028 "Ancho" => 3264 "Tamanyo" => 306839 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between the adult version of the Spanish Itch Severity Scale (ISS) and the modified Eczema Area and Severity (mEASI) (left) and between this ISS version and the Dermatology Life Quality Index (DLQI) (right).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Daudén, J. Sánchez-Perez, M. Prieto, M. Roset" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." 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Tung, B. Escutia, M. Blanes, M. Navarro, C. Pujol" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Y." "apellidos" => "Tung" "email" => array:1 [ 0 => "yale.tung@comv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Escutia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Blanes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Pujol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de hipersensibilidad inducido por sulfasalazina asociado a reactivación de VHH-6 e inducción de síndrome antifosfolípido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 648 "Ancho" => 800 "Tamanyo" => 68200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Nagayama spots. Purpuric rash on the soft palate and base of the uvula, characteristic of human herpesvirus 6 infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Drug-induced hypersensitivity syndrome (DIHS), also known as drug reaction with eosinophilia and systemic symptoms<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> or drug-induced delayed multiorgan hypersensitivity syndrome,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is a drug hypersensitivity disorder and must be suspected in any patient who develops fever, a rash, hepatitis, lymphadenopathy, and leukocytosis (with or without eosinophilia) between 2 weeks and 3 months after starting treatment with certain drugs (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The involvement of human herpesvirus (HHV) 6<span class="elsevierStyleHsp" style=""></span>has been reported by a number of study groups and has even been considered a risk factor for severity.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The relationship between HHV-6 reactivation and the severity of DIHS has led to such reactivation being considered a diagnostic criterion.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Activation of antiphospholipid antibodies<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and anti-thyroid peroxidase (anti-TPO) antibodies<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in these syndromes has also been reported, although how this may affect the severity of the disorder is unknown. The presence of such antibodies is not used for diagnostic purposes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a patient diagnosed with DIHS in whom we were able to demonstrate HHV-6 reactivation and the presence of antiphospholipid antibodies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient, a 27-year-old man, was transferred to our hospital from another center on suspicion of an acute lymphoproliferative syndrome. The only relevant finding in his past history was that he had started treatment with sulfasalazine one month earlier for chondromalacia patellae. At the time of admission he had fever of 40<span class="elsevierStyleHsp" style=""></span>°C, a confluent maculopapular rash with a negative Nikolsky sign (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), dyspepsia, and biliary vomiting. He also presented a 1-week history of pharyngoamygdalitis with a whitish exudate, a purpuric rash on the soft palate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and loss of the lingual papillae for which he had received antibiotic treatment with cefuroxime and paracetamol, with no improvement after a week of therapy. Physical examination revealed hepatosplenomegaly, jaundice (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and distal purpuric edema of the upper and lower limbs, associated with a painful lateral cervical and inguinal lymphadenopathy with mobile lymph nodes measuring 2 to 3<span class="elsevierStyleHsp" style=""></span>cm in diameter. Laboratory test results showed leukocytosis of 34 700/μL with left shift (neutrophils, 14 650/μL; lymphocytes, 12 750/μL); hemoglobin, 12.5<span class="elsevierStyleHsp" style=""></span>g/dL, platelets, 384 x 10<span class="elsevierStyleSup">3</span>/μL; prothrombin time, 20.1 s; prothrombin index, 58%; total proteins, 4.6<span class="elsevierStyleHsp" style=""></span>g/dL; urea, 90<span class="elsevierStyleHsp" style=""></span>mg/dL; creatinine 1.55<span class="elsevierStyleHsp" style=""></span>mg/dL; sodium, 126 mEq/L; potassium, 5.5<span class="elsevierStyleHsp" style=""></span>mEq/L; bilirubin, 10.1<span class="elsevierStyleHsp" style=""></span>mg/dL; aspartate aminotransferase, 628<span class="elsevierStyleHsp" style=""></span>IU/L; alanine aminotransferase, 521<span class="elsevierStyleHsp" style=""></span>IU/L; and lactate dehydrogenase, 2219<span class="elsevierStyleHsp" style=""></span>IU/L. There was no eosinophilia.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Thyroid function studies revealed a free thyroxine (T4) level of 1.01<span class="elsevierStyleHsp" style=""></span>ng/dL and a thyroid-stimulating hormone (TSH) concentration of 0.066<span class="elsevierStyleHsp" style=""></span>mIU/L. Anti-TPO antibodies were detected at a level of 0.3<span class="elsevierStyleHsp" style=""></span>IU/mL.</p><p id="par0035" class="elsevierStylePara elsevierViewall">There were no abnormalities in cytometry, which suggested that the condition was reactive in origin.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On skin biopsy, there were occasional necrotic keratinocytes in the epidermis with vacuolar degeneration of the basal layer and a predominantly lymphoid inflammatory infiltrate in the superficial dermis, findings consistent with toxicoderma. Computed tomography of neck, thorax, abdomen, and pelvis revealed multiple lymph nodes bilaterally.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Serology (enzyme-linked immunosorbent assay) for Epstein-Barr virus (EBV) (viral capsid antigen [VCA]), herpes simplex virus, cytomegalovirus (CMV), hepatitis A, B, and C viruses, parvovirus B19, measles virus, <span class="elsevierStyleItalic">Toxoplasma</span>, <span class="elsevierStyleItalic">Chlamydia trachomatis</span>, <span class="elsevierStyleItalic">Chlamydia pneumoniae</span>, <span class="elsevierStyleItalic">Chlamydia psittaci</span>, <span class="elsevierStyleItalic">Coxiella burnetti</span>, <span class="elsevierStyleItalic">Legionella</span>, <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span>, and human immunodeficiency virus, was positive for CMV immunoglobulin (Ig) G, EBV (VCA), and HHV-6 IgM and IgG. In addition, IgM anticardiolipin antibodies were later found to be positive.</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the basis of these findings and the past history of treatment with sulfasalazine, DIHS was diagnosed and treatment was started with intravenous methylprednisolone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day. This treatment produced a marked initial improvement, but progressive tapering of the dose and withdrawal of the corticosteroid led to recurrence of the condition. It was therefore decided to recommence therapy at the initial dose and taper more slowly.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Follow-up at 12 weeks found the patient to have marked hair loss on the scalp, but he was otherwise asymptomatic. Anticardiolipin IgG and IgM levels were within the normal ranges. However, thyroid function remained abnormal as follows: free T4, 0.41<span class="elsevierStyleHsp" style=""></span>ng/dL; TSH, 144.952<span class="elsevierStyleHsp" style=""></span>mU/L; and anti-TPO antibody levels of 57.36<span class="elsevierStyleHsp" style=""></span>U/mL.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">We present a case of DIHS, an uncommon but severe toxicoderma whose etiology, pathogenesis, and prognosis are related to HHV-6 reactivation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In some patients it can lead to the transient induction of anticardiolipin antibodies or an antiphospholipid syndrome.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The appearance of autoimmune disorders after an asymptomatic period is also relatively common.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Symptom severity is related to the duration of exposure to the drug after onset of the condition (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Recently, HHV-6 reactivation has also been included as a diagnostic criterion (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and has been linked to more severe disease because, in some series, it was associated with prolongation of the febrile state due to the severity of the hepatitis or renal failure; viral reactivation is a common finding in the cases with a fatal outcome.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> In addition, in our case we observed papular erythematous lesions on the soft palate and base of the uvula, known as Nagayama spots (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>); these are seen in up to 65% of patients with HHV-6 infection. Although many pediatricians use this sign as an early marker of infection, its specificity and predictive value continue to be a subject of discussion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">It has also been suggested that HHV-6 may play a possible pathogenic role in the induction of an antiphospholipid syndrome.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a> In many cases, as in the one we present, the presence of anticardiolipin antibodies is transient and the patient becomes antibody-negative after 2 to 3 months.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In our patient, despite the absence of signs of thrombosis consistent with antiphospholipid syndrome, anticardiolipin antibodies were detected at the onset of the disorder. We therefore recommend requesting laboratory studies for anticardiolipin antibodies, antinuclear antigen, and extractable nuclear antigen, in addition to markers of hemostasis, to monitor the clinical course of this dermatosis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is important to draw attention to the relative frequency with which autoimmune diseases can develop after resolution of the acute disorder; their pathogenesis is associated with suppressor T-cell dysfunction, cytotoxic T-cell activation and proliferation, and the appearance of autoantibodies, especially if preceded by viral reactivation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In particular, thyroid function must be monitored for many months after resolution of the condition, as hypothyroidism tends to be asymptomatic initially, but there is early induction of anti-TPO antibodies and a progressive rise in TSH concentrations and fall in free T4 levels, indicative of severe hypothyroidism.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The treatment of choice, in addition to withdrawal of the culprit drug, consists of systemic corticosteroid therapy. However, DIHS carries a mortality of up to 20%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Despite the controversy concerning the use of corticosteroids in the context of a possible viral infection, the cases described in the literature have presented a favorable clinical course after starting this treatment.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,13</span></a> It should also be emphasized that the dose of corticosteroid should be tapered slowly in order to avoid potential recurrences<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a>; this was done in our case.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion, when DIHS is suspected, the drug considered to be the cause must be withdrawn as early as possible. It should be noted that the causative drug may have been introduced up to 3 months before the onset of the condition. It is also important to screen for HHV-6 reactivation as not only is this one of the diagnostic criteria, but it also has prognostic value. Furthermore, treatment with systemic corticosteroids rather than being contraindicated is actually the treatment of choice, and it should be withdrawn slowly to prevent recurrence. In patients who develop thrombocytopenia, alterations of hemostasis, or associated thrombotic disorders, the presence of antiphospholipid antibodies should also be investigated. Finally, the possibility of the patient developing autoimmune disease as a sequela of the condition must also be considered; this requires medium-to-long-term monitoring and follow-up even after complete resolution of the syndrome.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres95331" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82491" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95332" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82492" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-08-04" "fechaAceptado" => "2010-12-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82491" "palabras" => array:5 [ 0 => "Drug-induced hypersensitivity" 1 => "Human herpesvirus 6" 2 => "Antiphospholipid syndrome" 3 => "Hypothyroidism" 4 => "Anti-thyroid peroxidase antibodies" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82492" "palabras" => array:5 [ 0 => "Hipersensibilidad inducida por fármacos" 1 => "Virus herpes humano-6" 2 => "Síndrome antifosfolípido" 3 => "Hipotiroidismo" 4 => "Anticuerpos Anti-TPO" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Drug-induced hypersensitivity syndrome is a toxicoderma with systemic involvement. Suspicion of this disorder obliges rapid withdrawal of the suspected drug, which may have been introduced up to 3 months earlier. Screening for human herpesvirus (HHV) 6 reactivation is important both for its diagnostic value and for its association with a poor prognosis. Reactivation of this virus is not a contraindication for systemic corticosteroid treatment, which should be tapered slowly in order to avoid recurrence. The possible appearance of antiphospholipid antibodies must also be considered in those cases associated with thrombocytopenia, altered hemostasis, or thrombotic events. Autoimmune disorders may also develop as a sequela of the condition. Medium-to-long-term follow-up is required even after complete resolution of the condition. We describe a new case of sulfasalazine-induced hypersensitivity syndrome associated with HHV-6 reactivation and the induction of anticardiolipin and anti-thyroid peroxidase antibodies.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El síndrome de hipersensibilidad inducido por fármacos (DIHS) se engloba dentro de los cuadros toxicodérmicos con afectación sistémica, cuya sospecha obliga a la retirada lo más precoz posible del fármaco que consideremos pueda estar implicado, que puede haber sido introducido hasta tres meses antes.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Es importante el despistaje de la reactivación del virus herpes humano (VHH) 6, tanto por su valor diagnóstico como por el pronóstico de gravedad que supone. Por otro lado, esta reactivación no contraindica que el tratamiento pueda llevarse a cabo con corticoides sistémicos, que además, deberán retirarse lentamente para evitar recaídas. Debería pensarse asimismo en la posibilidad de la presencia de anticuerpos antifofolipídicos en los casos en que apareciera trombopenia, alteración en la hemostasia o cuadros trombóticos asociados, como también tener en cuenta el desarrollo de procesos autoinmunes como secuela del cuadro, que requiere de monitorización y seguimiento a medio-largo plazo, a pesar de la resolución completa del cuadro.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Describimos un nuevo caso donde se muestra la reactivación del VHH-6, la activación de anticuerpos anticardiolipina y la inducción de anticuerpos anti-tiroperoxidasa (anti-TPO).</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Tung Y, et al. Síndrome de hipersensibilidad inducido por sulfasalazina asociado a reactivación de VHH-6 e inducción de síndrome antifosfolípido. Actas Dermosifiliogr. 2011;102:537-540.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 920 "Ancho" => 950 "Tamanyo" => 111557 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Confluent maculopapular rash on the trunk, with a negative Nikolsky sign.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 648 "Ancho" => 800 "Tamanyo" => 68200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Nagayama spots. Purpuric rash on the soft palate and base of the uvula, characteristic of human herpesvirus 6 infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 715 "Ancho" => 950 "Tamanyo" => 87293 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Maculopapular rash, jaundice, and desquamation of the lesions.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adapted from Shiohara T et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><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">1. Erythematous morbilliform rash 3 weeks after starting a new medication \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Persistence of symptoms at least 2 weeks after withdrawal of the medication \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Fever >38<span class="elsevierStyleHsp" style=""></span>°C \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Dysfunction of the liver (alanine aminotransferase > 100 U/L), kidney, or lungs \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Alterations of white cell populations: leukocytosis >11 000/mm<span class="elsevierStyleSup">3</span>, atypical lymphocytosis >5%, and/or eosinophilia >1500/mm<span class="elsevierStyleSup">3</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. Lymphadenopathies \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. Human herpesvirus 6 reactivation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181769.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">The diagnosis is confirmed by the presence of these 7 criteria (typical drug-induced hypersensitivity syndrome) or of the first 5 (atypical drug-induced hypersensitivity syndrome).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Diagnostic Criteria for Drug-Induced Hypersensitivity Syndrome.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Adapted from Eshki M et al,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Ben m’rad M et al,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and Ang CC et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><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"><span class="elsevierStyleItalic">Anticonvulsants</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carbamazepine, phenytoin, phenobarbital, lamotrigine, zonisamide \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Allopurinol</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Dapsone</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Antimicrobials</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minocycline and doxycycline, vancomycin, trimethoprim-sulfamethoxazole, beta-lactams, metronidazole, carbapenem, abacavir, and nevirapine \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Salazosulfapyridine</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Spironolactone</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Carbimazole</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Fluindione</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Nonsteroidal anti-inflammatory drugs</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">β-blockers</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Angiotensin-converting enzyme inhibitors</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Thalidomide</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ranitidine</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Methyldopa</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Calcium channel blockers</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Quinine</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Epoetin alfa</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Bupropion</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Biological therapy:</span> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Imatinib, efalizumab \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181768.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Drugs Reported to Cause Drug-Induced Hypersensitivity Syndrome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash With Eosinophilia and Systemic Symptoms: DRESS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 12 | 8 | 20 |
2024 Octubre | 115 | 55 | 170 |
2024 Septiembre | 108 | 25 | 133 |
2024 Agosto | 147 | 77 | 224 |
2024 Julio | 106 | 45 | 151 |
2024 Junio | 152 | 57 | 209 |
2024 Mayo | 127 | 63 | 190 |
2024 Abril | 135 | 60 | 195 |
2024 Marzo | 143 | 48 | 191 |
2024 Febrero | 99 | 52 | 151 |
2024 Enero | 91 | 58 | 149 |
2023 Diciembre | 111 | 30 | 141 |
2023 Noviembre | 123 | 41 | 164 |
2023 Octubre | 89 | 41 | 130 |
2023 Septiembre | 115 | 42 | 157 |
2023 Agosto | 98 | 35 | 133 |
2023 Julio | 110 | 68 | 178 |
2023 Junio | 115 | 26 | 141 |
2023 Mayo | 104 | 53 | 157 |
2023 Abril | 65 | 36 | 101 |
2023 Marzo | 73 | 37 | 110 |
2023 Febrero | 61 | 34 | 95 |
2023 Enero | 55 | 41 | 96 |
2022 Diciembre | 90 | 54 | 144 |
2022 Noviembre | 56 | 29 | 85 |
2022 Octubre | 47 | 31 | 78 |
2022 Septiembre | 64 | 37 | 101 |
2022 Agosto | 43 | 44 | 87 |
2022 Julio | 38 | 43 | 81 |
2022 Junio | 27 | 23 | 50 |
2022 Mayo | 60 | 49 | 109 |
2022 Abril | 65 | 41 | 106 |
2022 Marzo | 78 | 49 | 127 |
2022 Febrero | 119 | 33 | 152 |
2022 Enero | 101 | 45 | 146 |
2021 Diciembre | 79 | 55 | 134 |
2021 Noviembre | 77 | 53 | 130 |
2021 Octubre | 75 | 61 | 136 |
2021 Septiembre | 86 | 48 | 134 |
2021 Agosto | 80 | 39 | 119 |
2021 Julio | 65 | 28 | 93 |
2021 Junio | 71 | 57 | 128 |
2021 Mayo | 63 | 53 | 116 |
2021 Abril | 155 | 122 | 277 |
2021 Marzo | 146 | 40 | 186 |
2021 Febrero | 78 | 42 | 120 |
2021 Enero | 77 | 36 | 113 |
2020 Diciembre | 58 | 29 | 87 |
2020 Noviembre | 52 | 27 | 79 |
2020 Octubre | 77 | 27 | 104 |
2020 Septiembre | 73 | 20 | 93 |
2020 Agosto | 59 | 29 | 88 |
2020 Julio | 65 | 21 | 86 |
2020 Junio | 56 | 28 | 84 |
2020 Mayo | 65 | 37 | 102 |
2020 Abril | 56 | 23 | 79 |
2020 Marzo | 41 | 29 | 70 |
2020 Febrero | 3 | 17 | 20 |
2020 Enero | 1 | 8 | 9 |
2019 Diciembre | 4 | 7 | 11 |
2019 Noviembre | 0 | 8 | 8 |
2019 Octubre | 4 | 4 | 8 |
2019 Septiembre | 4 | 8 | 12 |
2019 Agosto | 1 | 4 | 5 |
2019 Julio | 0 | 20 | 20 |
2019 Junio | 4 | 29 | 33 |
2019 Mayo | 0 | 51 | 51 |
2019 Abril | 0 | 62 | 62 |
2019 Marzo | 3 | 18 | 21 |
2019 Febrero | 4 | 13 | 17 |
2019 Enero | 3 | 14 | 17 |
2018 Diciembre | 12 | 11 | 23 |
2018 Noviembre | 4 | 0 | 4 |
2018 Octubre | 3 | 0 | 3 |
2018 Septiembre | 2 | 2 | 4 |
2018 Agosto | 0 | 5 | 5 |
2018 Julio | 0 | 9 | 9 |
2018 Junio | 0 | 8 | 8 |
2018 Mayo | 0 | 17 | 17 |
2018 Abril | 0 | 4 | 4 |
2018 Marzo | 2 | 1 | 3 |
2018 Febrero | 132 | 1 | 133 |
2018 Enero | 139 | 18 | 157 |
2017 Diciembre | 154 | 6 | 160 |
2017 Noviembre | 117 | 15 | 132 |
2017 Octubre | 124 | 14 | 138 |
2017 Septiembre | 103 | 19 | 122 |
2017 Agosto | 110 | 14 | 124 |
2017 Julio | 107 | 9 | 116 |
2017 Junio | 107 | 19 | 126 |
2017 Mayo | 99 | 14 | 113 |
2017 Abril | 94 | 12 | 106 |
2017 Marzo | 98 | 24 | 122 |
2017 Febrero | 96 | 10 | 106 |
2017 Enero | 97 | 16 | 113 |
2016 Diciembre | 115 | 10 | 125 |
2016 Noviembre | 195 | 7 | 202 |
2016 Octubre | 217 | 14 | 231 |
2016 Septiembre | 206 | 12 | 218 |
2016 Agosto | 214 | 11 | 225 |
2016 Julio | 90 | 6 | 96 |
2016 Junio | 12 | 9 | 21 |
2016 Mayo | 8 | 8 | 16 |
2016 Abril | 11 | 5 | 16 |
2016 Marzo | 9 | 3 | 12 |
2016 Febrero | 12 | 5 | 17 |
2016 Enero | 5 | 11 | 16 |
2015 Diciembre | 8 | 1 | 9 |
2015 Noviembre | 55 | 11 | 66 |
2015 Octubre | 96 | 12 | 108 |
2015 Septiembre | 107 | 7 | 114 |
2015 Agosto | 24 | 3 | 27 |
2015 Julio | 213 | 13 | 226 |
2015 Junio | 122 | 11 | 133 |
2015 Mayo | 121 | 15 | 136 |
2015 Abril | 143 | 17 | 160 |
2015 Marzo | 176 | 11 | 187 |
2015 Febrero | 210 | 11 | 221 |
2015 Enero | 113 | 16 | 129 |
2014 Diciembre | 91 | 22 | 113 |
2014 Noviembre | 58 | 13 | 71 |
2014 Octubre | 85 | 11 | 96 |
2014 Septiembre | 133 | 14 | 147 |
2014 Agosto | 124 | 20 | 144 |
2014 Julio | 185 | 15 | 200 |
2014 Junio | 131 | 13 | 144 |
2014 Mayo | 134 | 16 | 150 |
2014 Abril | 126 | 9 | 135 |
2014 Marzo | 91 | 16 | 107 |
2014 Febrero | 50 | 32 | 82 |
2014 Enero | 45 | 20 | 65 |
2013 Diciembre | 41 | 14 | 55 |
2013 Noviembre | 34 | 17 | 51 |
2013 Octubre | 45 | 19 | 64 |
2013 Septiembre | 32 | 20 | 52 |
2013 Agosto | 10 | 12 | 22 |
2013 Julio | 8 | 32 | 40 |
2013 Junio | 9 | 23 | 32 |
2013 Mayo | 12 | 24 | 36 |
2013 Abril | 16 | 30 | 46 |
2013 Marzo | 18 | 12 | 30 |
2013 Febrero | 62 | 6 | 68 |
2013 Enero | 45 | 7 | 52 |
2012 Diciembre | 25 | 4 | 29 |
2012 Octubre | 1 | 3 | 4 |
2012 Septiembre | 2 | 1 | 3 |