Case and Research Letters
Systemic Sclerosis With Sarcoidosis and Skin Manifestations: A Case Report
Esclerodermia sistémica asociada a sarcoidosis con afectación cutánea: a propósito de un caso
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"apellidos" => "Alomar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, 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" => "Esclerodermia sistémica asociada a sarcoidosis con afectación cutánea: a propósito de un caso" ] ] "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" => 710 "Ancho" => 950 "Tamanyo" => 205555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epithelioid granulomas in the dermis identified in a skin biopsy taken from the patient's back, hematoxylin-eosin, original magnification ×200.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis has been associated with various autoimmune processes, including primary biliary cirrhosis, autoimmune hepatitis, vitiligo, thyroiditis, and pernicious anemia,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> as well as connective tissue diseases such as Sjögren syndrome, polymyositis, systemic lupus erythematosus, and systemic sclerosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 59-year-old woman who in 2002 presented with progressive dyspnea, weight loss, and anorexia that had begun 1 year earlier. The patient's medical history included asthma and hypertension. A plain chest radiograph and chest computed tomography scan revealed a reticulonodular interstitial pattern in the middle and upper lung fields accompanied by mediastinal lymphadenopathy, a clinical picture suggestive of sarcoidosis. Lung function testing showed a restrictive ventilation pattern (FVC, 44%; FEV<span class="elsevierStyleInf">1</span>, 38%) and a carbon monoxide diffusing capacity of 38% (normal<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>80%).</p><p id="par0015" class="elsevierStylePara elsevierViewall">During the physical examination, erythematous-desquamative papules and plaques on the back and arms were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histology of these lesions detected noncaseating granulomas with scarce lymphocytes, a finding compatible with a diagnosis of sarcoidosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Blood tests showed increased levels of angiotensin-converting enzyme at 271.1 U/L (reference range 19-79 U/L) and aldolase 13.7 U/L (reference value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7 U/L). The patient tested positive for lupus anticoagulant and high-titer antinuclear antibodies (><span class="elsevierStyleHsp" style=""></span>1:320) including anticentromere antibodies.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient reported the symptoms of Raynaud phenomenon. A thorough physical examination revealed sclerodactyly with scarring on the fingertips and telangiectasis on the fingertips and lips (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). During follow-up, a pruritic, erythematous-violaceous plaque was found on the right forearm; histologic testing of this lesion showed the presence of thickened collagen fibers in the dermis.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A plain radiograph of the hands and forearms demonstrated calcinosis. Esophageal manometry showed hypotonia in the middle and distal esophagus. Echocardiogram revealed diastolic dysfunction. No abnormalities were found in a biopsied muscle specimen.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was diagnosed with sarcoidosis and CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia), a type of systemic sclerosis. After treatment with prednisolone (60<span class="elsevierStyleHsp" style=""></span>mg/d) and nifedipine (10<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h), the clinical and radiographic aspects of the skin and lung involvement related to sarcoidosis improved. Azathioprine (100<span class="elsevierStyleHsp" style=""></span>mg/d) was later added to the regimen. The dose of prednisolone was tapered gradually and the drug was discontinued 1 year after start of treatment; treatment with azathioprine was maintained.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2004, the patient presented with an episode of anterior uveitis; in the same year she was admitted to hospital for pulmonary sarcoidosis progression. At that time, systemic corticosteroid treatment and oral colchicine were added to her treatment regimen. Systemic corticosteroid treatment was withdrawn in 2006, colchicine in 2008, and azathioprine in 2009. The patient is currently asymptomatic and receiving no treatment. The skin lesions associated with sarcoidosis have disappeared and her lung function test results are normal.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our review of the literature we found 24 patients with systemic sclerosis and sarcoidosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–8</span></a> Fifteen of these patients were diagnosed with systemic sclerosis between 2 and 30 years prior to being diagnosed with sarcoidosis. In 6 patients both diseases appeared simultaneously, and in 3 sarcoidosis appeared before systemic sclerosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important to emphasize that it can be difficult to differentiate between these 2 diseases because the respiratory manifestations may be similar.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> Skin tests play a crucial role in the diagnosis of both processes. In our patient, histopathologic examination of the skin lesions confirmed sarcoidosis. We found only 1 case of cutaneous sarcoidal granulomas in the literature.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In the present case, a thorough examination of the skin revealed systemic sclerosis (CREST syndrome). Whether concomitant sarcoidosis and autoimmune disease is a mere coincidence or the result of a common pathogenic mechanism has not been clearly established.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3-6</span></a> Cox et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and Takahashi et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> suggest that these 2 entities are probably the result of different pathogenic mechanisms because they do not appear simultaneously and the clinical course is different in each case. De Bandt et al.,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> however, suggest that a common etiology exists because most patients present with sarcoidosis and systemic sclerosis simultaneously.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Immunologic abnormalities found in patients with sarcoidosis include increased production of T cell derived cytokines (IL-2, IFN-γ) during the formation of granulomas, and an increase in macrophage-derived cytokines (IL-1, IL-6, IL-8, IL-15, tumor necrosis factor α, IFN-γ, and granulocyte-macrophage colony-stimulating factor), chemokines (macrophage inflammatory protein β and IL-16), and fibrogenic cytokines (transforming growth factor β, platelet-derived growth factor, and insulin-like growth factor 1) that induce fibrosis in patients with a persistent form of the disease.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In systemic sclerosis, the cytokines implicated in the induction of fibrosis are transforming growth factor β and platelet-derived growth factor, the same cytokines implicated in persistent sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, it is important to understand the processes involved in each of these two diseases and to take the appropriate action in patients with systemic sclerosis who develop sarcoid granulomas and in patients with sarcoidosis who develop sclerodermic lesions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Ferrer A, et al. Esclerodermia sistémica asociada a sarcoidosis con afectación cutánea a propósito de un caso. Actas Dermosifiliogr.2012;103:337-8.</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" => 639 "Ancho" => 950 "Tamanyo" => 117188 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules and plaques on the patient's back.</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" => 395 "Ancho" => 950 "Tamanyo" => 69129 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Telangiectasis on the lips.</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" => 710 "Ancho" => 950 "Tamanyo" => 205555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epithelioid granulomas in the dermis identified in a skin biopsy taken from the patient's back, hematoxylin-eosin, original magnification ×200.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous sarcoidosis associated with vitiligo, pernicious anaemia and autoimmune thyroiditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Barnadas" 1 => "J.M. Rodríguez-Arias" 2 => "A. Alomar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2000" "volumen" => "25" "paginaInicial" => "55" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10671975" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of cardiac sarcoidosis in a patient with progressive systemic sclerosis, Sjögren's syndrome, and polymiositis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Hosoya" 1 => "T. Mimura" 2 => "Y. Enokawa" 3 => "T. Mizuno" 4 => "K. Hamasaki" 5 => "T. Matsuyama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "1995" "volumen" => "34" "paginaInicial" => "1164" "paginaFinal" => "1167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8929642" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis in systemic sclerosis: report of 7 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Cox" 1 => "E. Conant" 2 => "L. Earle" 3 => "J. Newman" 4 => "B. Kahaleh" 5 => "S. Jimenez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "1995" "volumen" => "22" "paginaInicial" => "881" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8587076" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic sclerosis and sarcoidosis, a report of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. De Bandt" 1 => "S. Perrot" 2 => "C.H. Masson" 3 => "O. Meyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Rheumatol" "fecha" => "1997" "volumen" => "36" "paginaInicial" => "117" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9117150" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis in a patient with systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Castillo Palma" 1 => "J. Sánchez Román" 2 => "C. Ocaña Medina" 3 => "F. Gavilán Carrasco" 4 => "J. Martín Juan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "1999" "volumen" => "112" "paginaInicial" => "597" "paginaFinal" => "598" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Success of prednisone in the treatment of a patient with sarcoidosis and systemic sclerosis: Report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Borges da Costa" 1 => "A. Mayer-da-Silva" 2 => "L.M. Soares de Almeida" 3 => "M. Marques Gomes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20040261" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of progressive systemic sclerosis associated with sarcoidosis and esophageal adenocarcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Maekawa" 1 => "R. Nogami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "1993" "volumen" => "20" "paginaInicial" => "45" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8482751" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of progressive systemic sclerosis with pulmonary sarcoidosis. Just a chance occurrence?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Takahashi" 1 => "M. Munakata" 2 => "Y. Homma" 3 => "Y. Kawakami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "1997" "volumen" => "36" "paginaInicial" => "435" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9213193" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Statement on sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.W. Hunninghake" 1 => "U. Costabel" 2 => "M. Ando" 3 => "R. Baughman" 4 => "J.F. Cordier" 5 => "R. du Bois" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.160.2.ats4-99" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1999" "volumen" => "160" "paginaInicial" => "736" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10430755" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overview of pathogenesis of systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.J. Abraham" 1 => "T. Krieg" 2 => "J. Distler" 3 => "O. Distler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "iii3" "paginaFinal" => "iii7" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000004/v1_201304241303/S1578219012001461/v1_201304241303/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000004/v1_201304241303/S1578219012001461/v1_201304241303/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001461?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 17 | 24 |
| 2024 Octubre | 79 | 54 | 133 |
| 2024 Septiembre | 108 | 38 | 146 |
| 2024 Agosto | 128 | 72 | 200 |
| 2024 Julio | 118 | 39 | 157 |
| 2024 Junio | 110 | 52 | 162 |
| 2024 Mayo | 92 | 40 | 132 |
| 2024 Abril | 102 | 34 | 136 |
| 2024 Marzo | 100 | 24 | 124 |
| 2024 Febrero | 87 | 40 | 127 |
| 2024 Enero | 73 | 37 | 110 |
| 2023 Diciembre | 72 | 26 | 98 |
| 2023 Noviembre | 83 | 28 | 111 |
| 2023 Octubre | 83 | 35 | 118 |
| 2023 Septiembre | 77 | 32 | 109 |
| 2023 Agosto | 69 | 24 | 93 |
| 2023 Julio | 95 | 30 | 125 |
| 2023 Junio | 88 | 27 | 115 |
| 2023 Mayo | 100 | 26 | 126 |
| 2023 Abril | 140 | 27 | 167 |
| 2023 Marzo | 148 | 34 | 182 |
| 2023 Febrero | 108 | 20 | 128 |
| 2023 Enero | 100 | 37 | 137 |
| 2022 Diciembre | 152 | 41 | 193 |
| 2022 Noviembre | 71 | 34 | 105 |
| 2022 Octubre | 94 | 28 | 122 |
| 2022 Septiembre | 74 | 50 | 124 |
| 2022 Agosto | 80 | 35 | 115 |
| 2022 Julio | 53 | 30 | 83 |
| 2022 Junio | 67 | 29 | 96 |
| 2022 Mayo | 151 | 43 | 194 |
| 2022 Abril | 212 | 56 | 268 |
| 2022 Marzo | 184 | 63 | 247 |
| 2022 Febrero | 188 | 52 | 240 |
| 2022 Enero | 168 | 57 | 225 |
| 2021 Diciembre | 104 | 44 | 148 |
| 2021 Noviembre | 116 | 69 | 185 |
| 2021 Octubre | 181 | 74 | 255 |
| 2021 Septiembre | 120 | 52 | 172 |
| 2021 Agosto | 103 | 79 | 182 |
| 2021 Julio | 53 | 48 | 101 |
| 2021 Junio | 63 | 50 | 113 |
| 2021 Mayo | 57 | 42 | 99 |
| 2021 Abril | 62 | 67 | 129 |
| 2021 Marzo | 56 | 36 | 92 |
| 2021 Febrero | 67 | 30 | 97 |
| 2021 Enero | 41 | 37 | 78 |
| 2020 Diciembre | 47 | 18 | 65 |
| 2020 Noviembre | 32 | 23 | 55 |
| 2020 Octubre | 27 | 10 | 37 |
| 2020 Septiembre | 41 | 12 | 53 |
| 2020 Agosto | 17 | 24 | 41 |
| 2020 Julio | 31 | 17 | 48 |
| 2020 Junio | 40 | 31 | 71 |
| 2020 Mayo | 19 | 22 | 41 |
| 2020 Abril | 32 | 26 | 58 |
| 2020 Marzo | 28 | 17 | 45 |
| 2020 Febrero | 8 | 6 | 14 |
| 2020 Enero | 4 | 5 | 9 |
| 2019 Diciembre | 8 | 4 | 12 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 8 | 2 | 10 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 7 | 11 |
| 2019 Junio | 6 | 2 | 8 |
| 2019 Mayo | 5 | 9 | 14 |
| 2019 Abril | 4 | 14 | 18 |
| 2019 Marzo | 2 | 4 | 6 |
| 2019 Febrero | 2 | 3 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 8 | 9 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 1 | 2 | 3 |
| 2018 Febrero | 60 | 3 | 63 |
| 2018 Enero | 78 | 10 | 88 |
| 2017 Diciembre | 89 | 8 | 97 |
| 2017 Noviembre | 83 | 12 | 95 |
| 2017 Octubre | 62 | 7 | 69 |
| 2017 Septiembre | 60 | 8 | 68 |
| 2017 Agosto | 91 | 15 | 106 |
| 2017 Julio | 67 | 15 | 82 |
| 2017 Junio | 93 | 29 | 122 |
| 2017 Mayo | 69 | 12 | 81 |
| 2017 Abril | 78 | 6 | 84 |
| 2017 Marzo | 72 | 28 | 100 |
| 2017 Febrero | 58 | 9 | 67 |
| 2017 Enero | 49 | 10 | 59 |
| 2016 Diciembre | 57 | 10 | 67 |
| 2016 Noviembre | 83 | 11 | 94 |
| 2016 Octubre | 107 | 22 | 129 |
| 2016 Septiembre | 113 | 6 | 119 |
| 2016 Agosto | 81 | 5 | 86 |
| 2016 Julio | 39 | 11 | 50 |
| 2016 Junio | 10 | 11 | 21 |
| 2016 Mayo | 10 | 6 | 16 |
| 2016 Abril | 5 | 10 | 15 |
| 2016 Marzo | 9 | 11 | 20 |
| 2016 Febrero | 7 | 16 | 23 |
| 2016 Enero | 6 | 9 | 15 |
| 2015 Diciembre | 7 | 5 | 12 |
| 2015 Noviembre | 13 | 10 | 23 |
| 2015 Octubre | 14 | 5 | 19 |
| 2015 Septiembre | 3 | 7 | 10 |
| 2015 Agosto | 11 | 1 | 12 |
| 2015 Julio | 109 | 1 | 110 |
| 2015 Junio | 83 | 12 | 95 |
| 2015 Mayo | 81 | 20 | 101 |
| 2015 Abril | 97 | 15 | 112 |
| 2015 Marzo | 71 | 14 | 85 |
| 2015 Febrero | 103 | 18 | 121 |
| 2015 Enero | 103 | 28 | 131 |
| 2014 Diciembre | 92 | 13 | 105 |
| 2014 Noviembre | 83 | 17 | 100 |
| 2014 Octubre | 84 | 13 | 97 |
| 2014 Septiembre | 86 | 11 | 97 |
| 2014 Agosto | 73 | 15 | 88 |
| 2014 Julio | 82 | 17 | 99 |
| 2014 Junio | 105 | 10 | 115 |
| 2014 Mayo | 115 | 12 | 127 |
| 2014 Abril | 45 | 5 | 50 |
| 2014 Marzo | 50 | 5 | 55 |
| 2014 Febrero | 56 | 9 | 65 |
| 2014 Enero | 41 | 10 | 51 |
| 2013 Diciembre | 38 | 10 | 48 |
| 2013 Noviembre | 27 | 6 | 33 |
| 2013 Octubre | 28 | 2 | 30 |
| 2013 Septiembre | 21 | 7 | 28 |
| 2013 Agosto | 34 | 5 | 39 |
| 2013 Julio | 12 | 13 | 25 |
| 2013 Junio | 8 | 16 | 24 |
| 2013 Mayo | 13 | 5 | 18 |
| 2013 Abril | 10 | 14 | 24 |
| 2013 Marzo | 18 | 10 | 28 |
| 2013 Febrero | 25 | 6 | 31 |
| 2013 Enero | 53 | 8 | 61 |
| 2012 Diciembre | 19 | 6 | 25 |
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