Case for Diagnosis
Papules and Nodules in an Infant
Pápulas y Nódulos en un Lactante
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Respuesta terapéutica a inmunoglobulinas pre y postparto" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 970 "Ancho" => 1397 "Tamanyo" => 121273 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Papular eruption with tense blisters on the patient's abdomen. B, Condition of the patient at 6 weeks after delivery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Ruiz-Villaverde, D. Sánchez-Cano, C.L. Ramirez-Tortosa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 1 => array:2 [ "nombre" => "D." 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Fernández-Morano, J. del Boz, R. Fúnez-Liébana" "autores" => array:3 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Fernández-Morano" "email" => array:1 [ 0 => "tfm_84@hotmail.com" ] "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" => "J." "apellidos" => "del Boz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Fúnez-Liébana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas y Nódulos en un Lactante" ] ] "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" => 724 "Ancho" => 904 "Tamanyo" => 241362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 5-week-old girl with no relevant history apart from readmission at 6 days of life for hyperbilirubinemia requiring phototherapy (19.2<span class="elsevierStyleHsp" style=""></span>mg/dL), at which time monocytosis (21.2%) was detected, was sent from the emergency department with progressive cutaneous lesions that had begun to appear a week earlier.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Multiple purpuric, erythematous papular and nodular lesions that felt infiltrated were distributed mainly on the torso, extremities, head, and perianal region; lesions were not found on the palms, soles, or mucosal surfaces (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Pallor and hepatosplenomegaly were also noted.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">On biopsy, an abdominal lesion showed a diffuse dermal infiltration, with involvement of subcutaneous tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>); the infiltrate showed atypical cells with scant cytoplasm and a few mitotic figures (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) that were positive for CD45, CD68, and CD4.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">A new blood test revealed leukocytosis with monocytosis (70.2%); a blood smear showed 80% immature monocytes. Ultrasound identified hepatosplenomegaly and mild pulmonary stenosis. Serology was negative for TORCH infections (toxoplasmosis, other infections, including syphilis, parvovirus, and coxsackievirus, rubella, cytomegalovirus, herpes simplex virus).</p><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Congenital leukemia cutis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">After diagnosis, bone marrow studies confirmed the presence of acute monocytic leukemia (class M5). Polychemotherapy was initiated according to the SHOP-LANL-2001 protocol, followed by hematopoietic progenitor cell transplantation. The patient later died at the age of 7 months.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Leukemia cutis, which occurs when leukemic cells infiltrate skin tissue, has been documented in 25% to 30% of patients with congenital leukemia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> Leukemia is considered congenital when it appears in the first 4 to 6 weeks of life.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,5</span></a> Acute myeloid leukemia is the most common congenital type and the one that most often involves the skin.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Most patients present generalized violaceous nodules, with oral lesions appearing in 1% of cases. Adult monocytic leukemia, in contrast, involves oral infiltration much more frequently.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This condition has been referred to as blueberry muffin baby syndrome<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4,6</span></a> because the lesions resemble these muffins. Similar clinical manifestations may be seen in other serious conditions, such as congenital TORCH infections, hemolytic disease of the newborn (blood type incompatibility), hereditary spherocytosis, twin-to-twin transfusion syndrome, or other proliferative processes (histiocytosis, neuroblastoma metastasis, or rhabdomyosarcoma).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Congenital leukemia cutis has been reported in Spain and internationally.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> The most extensive literature review, published in 1993, reported cutaneous involvement in 56 out of 175 cases of congenital leukemia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Approximately 15 new cases of congenital leukemia cutis have since been reported.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Cutaneous manifestations may be present during the terminal phase, once the leukemia has started, or at the initial stage of the disease (10% of cases), with skin lesions occurring before tumor cell blasts are detected in peripheral blood and bone marrow.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The treatment of choice is chemotherapy with hematopoietic progenitor cell transplantation. Isolated cases of spontaneous remission have been reported, all in the absence of progressive leukemia or 11q23 translocations<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and some involving relapse after a certain number of weeks or years<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a>; withholding treatment is therefore controversial.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The role of the dermatologist is essential in the identification and early diagnosis of these cutaneous lesions because underlying severe systemic conditions may be present. If congenital leukemia cutis is suspected, a biopsy of the lesions and complementary immunohistochemical assays will provide key diagnostic information.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0075" 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" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Fernández-Morano T, et al. Pápulas y nódulos en un lactante. Actas Dermosifiliogr. 2011;102:733-734.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 904 "Tamanyo" => 89552 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple purpuric, erythematous papular and nodular lesions.</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" => 745 "Ancho" => 904 "Tamanyo" => 103135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>10.</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" => 724 "Ancho" => 904 "Tamanyo" => 241362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukemia cutis in congenital leukemia. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 12 | 17 |
| 2024 Octubre | 77 | 45 | 122 |
| 2024 Septiembre | 83 | 34 | 117 |
| 2024 Agosto | 122 | 43 | 165 |
| 2024 Julio | 94 | 40 | 134 |
| 2024 Junio | 101 | 60 | 161 |
| 2024 Mayo | 75 | 44 | 119 |
| 2024 Abril | 69 | 19 | 88 |
| 2024 Marzo | 98 | 29 | 127 |
| 2024 Febrero | 60 | 30 | 90 |
| 2024 Enero | 59 | 32 | 91 |
| 2023 Diciembre | 78 | 18 | 96 |
| 2023 Noviembre | 87 | 27 | 114 |
| 2023 Octubre | 51 | 16 | 67 |
| 2023 Septiembre | 77 | 35 | 112 |
| 2023 Agosto | 54 | 19 | 73 |
| 2023 Julio | 49 | 29 | 78 |
| 2023 Junio | 48 | 17 | 65 |
| 2023 Mayo | 79 | 22 | 101 |
| 2023 Abril | 67 | 18 | 85 |
| 2023 Marzo | 61 | 16 | 77 |
| 2023 Febrero | 41 | 18 | 59 |
| 2023 Enero | 44 | 24 | 68 |
| 2022 Diciembre | 66 | 50 | 116 |
| 2022 Noviembre | 18 | 19 | 37 |
| 2022 Octubre | 29 | 21 | 50 |
| 2022 Septiembre | 27 | 36 | 63 |
| 2022 Agosto | 26 | 28 | 54 |
| 2022 Julio | 32 | 28 | 60 |
| 2022 Junio | 29 | 19 | 48 |
| 2022 Mayo | 64 | 32 | 96 |
| 2022 Abril | 66 | 33 | 99 |
| 2022 Marzo | 89 | 59 | 148 |
| 2022 Febrero | 69 | 29 | 98 |
| 2022 Enero | 80 | 38 | 118 |
| 2021 Diciembre | 63 | 42 | 105 |
| 2021 Noviembre | 67 | 38 | 105 |
| 2021 Octubre | 70 | 51 | 121 |
| 2021 Septiembre | 49 | 36 | 85 |
| 2021 Agosto | 43 | 31 | 74 |
| 2021 Julio | 66 | 23 | 89 |
| 2021 Junio | 50 | 20 | 70 |
| 2021 Mayo | 66 | 39 | 105 |
| 2021 Abril | 116 | 72 | 188 |
| 2021 Marzo | 46 | 20 | 66 |
| 2021 Febrero | 70 | 23 | 93 |
| 2021 Enero | 33 | 17 | 50 |
| 2020 Diciembre | 35 | 19 | 54 |
| 2020 Noviembre | 40 | 16 | 56 |
| 2020 Octubre | 29 | 10 | 39 |
| 2020 Septiembre | 34 | 8 | 42 |
| 2020 Agosto | 31 | 22 | 53 |
| 2020 Julio | 24 | 14 | 38 |
| 2020 Junio | 31 | 30 | 61 |
| 2020 Mayo | 17 | 14 | 31 |
| 2020 Abril | 34 | 17 | 51 |
| 2020 Marzo | 34 | 30 | 64 |
| 2020 Febrero | 6 | 2 | 8 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Julio | 0 | 3 | 3 |
| 2019 Junio | 2 | 8 | 10 |
| 2019 Mayo | 1 | 24 | 25 |
| 2019 Abril | 0 | 6 | 6 |
| 2019 Marzo | 3 | 3 | 6 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Marzo | 3 | 0 | 3 |
| 2018 Febrero | 38 | 7 | 45 |
| 2018 Enero | 56 | 8 | 64 |
| 2017 Diciembre | 56 | 7 | 63 |
| 2017 Noviembre | 52 | 9 | 61 |
| 2017 Octubre | 41 | 10 | 51 |
| 2017 Septiembre | 33 | 6 | 39 |
| 2017 Agosto | 35 | 9 | 44 |
| 2017 Julio | 34 | 3 | 37 |
| 2017 Junio | 52 | 12 | 64 |
| 2017 Mayo | 58 | 4 | 62 |
| 2017 Abril | 50 | 17 | 67 |
| 2017 Marzo | 50 | 28 | 78 |
| 2017 Febrero | 95 | 13 | 108 |
| 2017 Enero | 37 | 8 | 45 |
| 2016 Diciembre | 65 | 5 | 70 |
| 2016 Noviembre | 69 | 8 | 77 |
| 2016 Octubre | 90 | 20 | 110 |
| 2016 Septiembre | 130 | 5 | 135 |
| 2016 Agosto | 79 | 12 | 91 |
| 2016 Julio | 52 | 16 | 68 |
| 2016 Junio | 13 | 7 | 20 |
| 2016 Mayo | 10 | 13 | 23 |
| 2016 Abril | 6 | 4 | 10 |
| 2016 Marzo | 7 | 9 | 16 |
| 2016 Febrero | 6 | 4 | 10 |
| 2016 Enero | 15 | 0 | 15 |
| 2015 Diciembre | 19 | 5 | 24 |
| 2015 Noviembre | 26 | 0 | 26 |
| 2015 Octubre | 39 | 3 | 42 |
| 2015 Septiembre | 37 | 7 | 44 |
| 2015 Agosto | 22 | 5 | 27 |
| 2015 Julio | 48 | 10 | 58 |
| 2015 Junio | 66 | 9 | 75 |
| 2015 Mayo | 69 | 19 | 88 |
| 2015 Abril | 68 | 14 | 82 |
| 2015 Marzo | 64 | 7 | 71 |
| 2015 Febrero | 36 | 9 | 45 |
| 2015 Enero | 54 | 13 | 67 |
| 2014 Diciembre | 38 | 12 | 50 |
| 2014 Noviembre | 33 | 13 | 46 |
| 2014 Octubre | 44 | 12 | 56 |
| 2014 Septiembre | 32 | 10 | 42 |
| 2014 Agosto | 43 | 13 | 56 |
| 2014 Julio | 54 | 19 | 73 |
| 2014 Junio | 59 | 10 | 69 |
| 2014 Mayo | 88 | 16 | 104 |
| 2014 Abril | 64 | 7 | 71 |
| 2014 Marzo | 62 | 12 | 74 |
| 2014 Febrero | 62 | 8 | 70 |
| 2014 Enero | 49 | 15 | 64 |
| 2013 Diciembre | 42 | 7 | 49 |
| 2013 Noviembre | 33 | 6 | 39 |
| 2013 Octubre | 14 | 6 | 20 |
| 2013 Septiembre | 12 | 5 | 17 |
| 2013 Agosto | 12 | 4 | 16 |
| 2013 Julio | 16 | 10 | 26 |
| 2013 Junio | 11 | 4 | 15 |
| 2013 Mayo | 20 | 1 | 21 |
| 2013 Abril | 24 | 8 | 32 |
| 2013 Marzo | 18 | 6 | 24 |
| 2013 Febrero | 24 | 4 | 28 |
| 2013 Enero | 31 | 5 | 36 |
| 2012 Diciembre | 14 | 3 | 17 |
| 2012 Agosto | 1 | 0 | 1 |
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