array:24 [
  "pii" => "S1578219013000383"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2013-04-01"
  "aid" => "577"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Actas Dermosifiliogr. 2013;104:239-41"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2194
    "formatos" => array:3 [
      "EPUB" => 46
      "HTML" => 1657
      "PDF" => 491
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S000173101200110X"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2011.08.014"
      "estado" => "S300"
      "fechaPublicacion" => "2013-04-01"
      "aid" => "577"
      "copyright" => "Elsevier España, S.L. and AEDV"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Actas Dermosifiliogr. 2013;104:239-41"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4090
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 2400
          "PDF" => 1687
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Hepatitis C aguda en un paciente en tratamiento con etanercept"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "239"
            "paginaFinal" => "241"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Acute Hepatitis C in a Patient Receiving Etanercept"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 563
                "Ancho" => 950
                "Tamanyo" => 139915
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Placas eritematodescamativas generalizadas previas al inicio del tratamiento con etanercept&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Armengot-Carb&#243;, M&#46; Velasco, R&#46; Giner, E&#46; Gimeno"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Armengot-Carb&#243;"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Velasco"
              ]
              2 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Giner"
              ]
              3 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Gimeno"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219013000383"
          "doi" => "10.1016/j.adengl.2011.08.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000383?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101200110X?idApp=UINPBA000044"
      "url" => "/00017310/0000010400000003/v1_201304241344/S000173101200110X/v1_201304241344/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219013000395"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.02.009"
    "estado" => "S300"
    "fechaPublicacion" => "2013-04-01"
    "aid" => "601"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Actas Dermosifiliogr. 2013;104:242-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5282
      "formatos" => array:3 [
        "EPUB" => 57
        "HTML" => 3806
        "PDF" => 1419
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Disseminated Juvenile Xanthogranuloma Associated With Follicular Lymphoma in an Adult&#58; Successful Treatment With Chemotherapy and Rituximab&#46; A Review of the Literature"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "242"
          "paginaFinal" => "246"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Xantogranuloma juvenil diseminado del adulto asociado a linfoma folicular&#44; respuesta completa a quimioterapia y rituximab&#46; Revisi&#243;n de la literatura"
        ]
      ]
      "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" => 1565
              "Ancho" => 1655
              "Tamanyo" => 562382
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A&#44; Infiltrate composed of cells with abundant cytoplasm and a histiocytic appearance&#44; some multinucleated giant cells&#44; lymphocytes with no atypia&#44; and a few eosinophils &#40;hematoxylin-eosin&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Immunohistochemistry showing a negative result for CD1a &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>200&#41;&#46; C&#44; Immunohistochemistry showing granular positivity for CD68 in the cellular cytoplasm &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>200&#41;&#46; D&#44; Histology of inguinal lymph node showing a lymphoid proliferation of centrocytes &#40;small cleaved cells&#41; &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "B&#46; Narv&#225;ez-Moreno, &#193;&#46; Pulpillo-Ruiz, T&#46; De Zulueta-Dorado, J&#46; Conejo-Mir"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Narv&#225;ez-Moreno"
            ]
            1 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Pulpillo-Ruiz"
            ]
            2 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "De Zulueta-Dorado"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Conejo-Mir"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731012001585"
        "doi" => "10.1016/j.ad.2012.02.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012001585?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000395?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000395/v1_201304241622/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219013000371"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.10.008"
    "estado" => "S300"
    "fechaPublicacion" => "2013-04-01"
    "aid" => "764"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2013;104:232-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3662
      "formatos" => array:3 [
        "EPUB" => 43
        "HTML" => 2625
        "PDF" => 994
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prevalence of Antiphospholipid Antibodies in Patients With Subacute and Chronic Cutaneous Lupus Erythematosus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "232"
          "paginaFinal" => "238"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia de anticuerpos antifosfolipido en pacientes con lupus eritematoso cut&#225;neo subagudo y cr&#243;nico"
        ]
      ]
      "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" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2170
              "Ancho" => 3170
              "Tamanyo" => 350440
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm&#46; Abbreviations&#58; CLE indicates cutaneous lupus erythematosus&#59; SLE&#44; systemic lupus erythematosus&#59; ANA&#44; antinuclear antibodies&#59; aPTT&#44; activated partial thromboplastin time&#59; LA&#44; lupus anticoagulant&#59; ACA&#44; anticardiolipin antibodies&#59; anti-&#946;<span class="elsevierStyleInf">2</span>GPI&#44; anti-&#946;<span class="elsevierStyleInf">2</span>-glycoprotein I&#59; APS&#44; antiphospholipid syndrome&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Garc&#237;a-Mart&#237;n, C&#46; Garc&#237;a-Garc&#237;a, J&#46; Fraga, A&#46; Garc&#237;a-D&#237;ez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Garc&#237;a-Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Garc&#237;a-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Fraga"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-D&#237;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101200539X"
        "doi" => "10.1016/j.ad.2012.10.017"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101200539X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000371?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000371/v1_201304241622/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Acute Hepatitis C in a Patient Receiving Etanercept"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "239"
        "paginaFinal" => "241"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Armengot-Carb&#243;, M&#46; Velasco, R&#46; Giner, E&#46; Gimeno"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Armengot-Carb&#243;"
            "email" => array:1 [
              0 => "miquelarmengot&#64;gmail&#46;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" => "M&#46;"
            "apellidos" => "Velasco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Giner"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Gimeno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Arnau de Vilanova&#44; Valencia&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Digestiva&#44; Hospital Arnau de Vilanova&#44; Valencia&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hepatitis C aguda en un paciente en tratamiento con etanercept"
      ]
    ]
    "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" => 938
            "Ancho" => 1585
            "Tamanyo" => 222383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Widespread desquamating erythematous plaques prior to the onset of treatment with etanercept&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tumor necrosis factor &#40;TNF&#41; antagonists have been used to treat a variety of conditions in patients with chronic hepatitis C virus &#40;HCV&#41; infection&#44; as shown by numerous case reports in the literature&#46; However&#44; we have found no reports of primary HCV infection that occurred after treatment with an anti-TNF biologic had been started&#46; We present such a case of primary HCV infection that occurred while the patient was on etanercept for psoriasis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old man with a history of smoking and anxiety had long-standing moderate-severe psoriasis that had been treated with corticosteroids and vitamin D analogs since 1999&#46; In 2005 our department prescribed treatment with methotrexate at a weekly dose of 15<span class="elsevierStyleHsp" style=""></span>mg&#46; Response was good&#46; However&#44; symptoms worsened after 6 months&#44; when a psoriasis area and severity index &#40;PASI&#41; of 23 was reached &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The advisability of treating this particular patient with a biologic agent was then considered&#46; The pretreatment complete blood count and biochemistry showed normal values&#44; and a chest radiograph was unremarkable&#46; A tuberculin skin test and serology for HBV&#44; HCV&#44; and the human immunodeficiency virus were negative&#46; Treatment with etanercept was begun in 2006 with the usual regimen of 50<span class="elsevierStyleHsp" style=""></span>mg twice weekly for 3 months and followed with once-weekly administration thereafter&#46; PASI 0 was reached after 6 months&#46; Several relapses occurred between 2006 and 2009 on withdrawal of etanercept&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">While the patient was on etanercept in 2009&#44; elevated transaminase levels were detected on routine testing &#40;alanine aminotransferase&#44; 710<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#59; aspartate aminotransferase&#44; 647<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#41;&#46; When the blood tests and viral serology were repeated&#44; elevated liver enzyme levels were confirmed and HCV seroconversion was revealed&#46; The patient was referred to the gastroenterology department&#44; where complementary tests were ordered&#46; The diagnosis was acute HCV infection &#40;viral load<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10 million copies&#47;mL&#44; genotype 1a&#41;&#46; The patient reported not having received transfusions or undergone surgery recently&#46; He denied parenteral drug use and high-risk sexual activities&#46; The probable source of contact was judged to be his wife&#44; who was found to harbor HCV&#46; This chronic infection had not been diagnosed before her husband&#39;s acute infection led to testing&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Etanercept treatment was not interrupted&#46; Given the patient&#39;s progressively increasing transaminase levels and viral load&#44; pegylated interferon-alpha was prescribed in November 2009&#46; Transaminase levels and viral load responded rapidly&#44; but worsening psoriasis symptoms were an expected effect of the interferon treatment&#46; A higher etanercept dose &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;wk&#41; achieved partial response&#46; The antiviral treatment was continued for 24 weeks&#44; and sustained viral response was confirmed at the time of writing&#44; The higher dose of etanercept was used throughout the duration of interferon treatment and in the month after antiviral therapy was stopped&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">TNF&#44; a proinflammatory cytokine secreted by monocytes and macrophages&#44; is implicated in the immune response to infections&#46; Treatment with anti-TNF agents therefore increases the likelihood that latent bacterial &#40;e&#46;g&#46;&#44; mycobacterial&#41; or fungal infections will be reactivated&#46; However&#44; the effect of these agents on viral infections is less well understood&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In hepatitis viral infection&#44; elevated liver and serum levels of TNF and TNF receptors have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> In HBV infection&#44; TNF plays a key role in controlling viral replication&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; elevated levels of this cytokine are associated with greater hepatocellular damage in HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> TNF also appears to be implicated in the pathogenesis of fibrosis of the liver&#44; which leads to cirrhosis in 20&#37; of HCV-infected patients over a period of 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Anti-TNF agents might therefore even prove beneficial for some of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> In our patient&#44; treatment with etanercept may have attenuated liver damage secondary to the primary acute HCV infection&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the possible adverse effect of anti-TNF agents on viral load or disease progression&#44; relevant information can be inferred from reports of more than 80 cases involving chronically HCV-infected patients under such treatment &#40;particularly with etanercept&#41; for a variety of autoimmune diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> The absence of significant changes in viral load and transaminase levels is a striking observation in these cases&#46; Paradisi and coworkers<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> recently reported the results of liver biopsy at baseline and after 12 months of etanercept treatment in 2 HCV-infected patients with psoriasis&#44; observing no progression of liver damage&#46; The use of anti-TNF agents in patients with chronic HCV infection therefore seems to be safe based on existing evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> However&#44; we were unable to find published cases like the one we report&#44; in which acute HCV infection occurred during anti-TNF treatment&#46; Our patient&#39;s course suggests that continuing etanercept in a primary infection like this one will not have an adverse effect on disease progression or the response to interferon&#44; although further confirmation is required&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Elevated TNF levels potentially also interfere with the response to antiviral treatment in HCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> In a small double-blind&#44; randomized placebo-controlled trial that assessed the possibility that etanercept might boost the effect of interferon&#8211;ribavirin treatment of chronic HCV infection&#44; the authors reported that the negativization of viral load was significantly greater in the etanercept group &#40;63&#37;&#41; than in the placebo group &#40;32&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In the case we report&#44; it is possible that in addition to a lack of an adverse effect of continued etanercept administration on the efficacy of the antiviral regimen&#44; etanercept may even have assisted HCV-RNA negativization&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; the fact that transmission in this case was by heterosexual contact suggests that even though clinical guidelines state that risk is low for this route&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> treatment with a biologic might increase the risk&#46; Evidently&#44; an exhaustive medical history should be taken for all patients on these drugs&#46; Candidates for anti-TNF therapy are screened for contact with tuberculosis&#46; It might also be useful to investigate the possibility of exposure to other diseases&#44; especially through contact with relatives or other persons who live with the patient&#44; so that we are not taken by surprise by infections that might compromise our patients&#8217; safety during treatment&#46; HBV vaccination is also necessary for patients with negative HBV serology in order to guard against primary infection during treatment with a biologic agent&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This is the first report of a case of primary HCV infection during a period of anti-TNF therapy&#46; The course of disease in our patient suggests that it is safe to maintain etanercept treatment in cases of acute HCV infection&#46; Just as etanercept does not have an adverse effect on the treatment of chronic infection&#44; there seems to be no interference in acute infection either&#46; This observation should be confirmed in larger series&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dr M&#46; Armengot-Carb&#243; has an agreement with Pfizer to collaborate on another publication&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Dr M&#46; Velasco and Dr E&#46; Gimeno have participated in clinical trials&#44; provided consulting services&#44; received speaking fees&#44; or accepted funding to attend conferences or training sessions from the following laboratories&#58; Pfizer&#44; Abbott&#44; and Janssen-Cilag&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dr R&#46; Giner declares that she has no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:2 [
          "identificador" => "xres97883"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec85038"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres97882"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec85039"
          "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" => "2011-06-28"
    "fechaAceptado" => "2011-08-27"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec85038"
          "palabras" => array:4 [
            0 => "Hepatitis C"
            1 => "Etanercept"
            2 => "TNF inhibitors"
            3 => "Psoriasis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec85039"
          "palabras" => array:4 [
            0 => "Hepatitis C"
            1 => "Etanercept"
            2 => "Antagonistas del TNF alfa"
            3 => "Psoriasis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">According to the literature&#44; the use of tumor necrosis factor &#40;TNF&#41; inhibitors in patients with chronic hepatitis C infection is safe and effective&#46; There have been no reports&#44; however&#44; of primary infection with the hepatitis C virus during treatment with a biologic agent&#46; We report the case of a patient with long-standing moderate to severe psoriasis who developed acute hepatitis C while being treated with etanercept&#46; Biologic therapy was continued and the infection was successfully treated with pegylated interferon&#44; which achieved a sustained virologic response&#46; Etanercept did not have a negative impact on disease outcome or on response to antiviral treatment&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El uso de agentes bloqueadores del factor de necrosis tumoral alfa &#40;anti-TNF&#945;&#41; en pacientes con hepatitis C cr&#243;nica ha sido descrito en la literatura en su conjunto como seguro y eficaz&#46; Sin embargo&#44; no se han descrito hasta la fecha casos de primoinfecci&#243;n por el virus de la hepatitis C ocurridos durante el tratamiento con un biol&#243;gico&#46; Presentamos un paciente con psoriasis moderada-severa de larga evoluci&#243;n que&#44; estando en tratamiento con etanercept&#44; sufri&#243; una hepatitis C aguda&#46; Sin suspender el f&#225;rmaco anti-TNF&#945; recibi&#243; tratamiento con interfer&#243;n pegilado&#44; con respuesta virol&#243;gica sostenida&#46; Etanercept no interfiri&#243; de forma negativa en la evoluci&#243;n de la enfermedad ni en la respuesta al tratamiento antiviral&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Armengot-Carb&#243; M&#44; et al&#46; Hepatitis C aguda en un paciente en tratamiento con etanercept&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;239&#8211;41&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 938
            "Ancho" => 1585
            "Tamanyo" => 222383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Widespread desquamating erythematous plaques prior to the onset of treatment with etanercept&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept e infecci&#243;n cr&#243;nica por los virus de la hepatitis C y B"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "X&#46; Bordas"
                            1 => "S&#46; Mart&#237;n-Sala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "82"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20492886"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642007003429"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Afectaci&#243;n hep&#225;tica biol&#243;gica en el tratamiento de la psoriasis&#46; Consideraciones pr&#225;cticas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Llamas-Velasco"
                            1 => "R&#46; Navarro"
                            2 => "M&#46;J&#46; Concha"
                            3 => "E&#46; Daud&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of psoriasis and psoriatic arthritis&#58; Section 1&#46; Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Menter"
                            1 => "A&#46; Gottlieb"
                            2 => "S&#46;R&#46; Feldman"
                            3 => "A&#46;S&#46; Van Voorhees"
                            4 => "C&#46;L&#46; Leonardi"
                            5 => "K&#46;B&#46; Gordon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2008.02.039"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2008"
                        "volumen" => "58"
                        "paginaInicial" => "826"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18423260"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002939410001157"
                          "estado" => "S300"
                          "issn" => "00029394"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumour necrosis factor-&#945; antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C&#58; a retrospective analysis of 17 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Prignano"
                            1 => "F&#46; Ricceri"
                            2 => "L&#46; Pescitelli"
                            3 => "F&#46; Zanieri"
                            4 => "T&#46; Lotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2010.10140.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "164"
                        "paginaInicial" => "645"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21375517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of etanercept in patients with psoriasis and hepatitis C virus assessed by liver histopathology&#58; preliminary data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Paradisi"
                            1 => "G&#46; Caldarola"
                            2 => "R&#46; Capizzi"
                            3 => "M&#46; Siciliano"
                            4 => "E&#46; Annichiarico"
                            5 => "F&#46;M&#46; Vecchio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2009.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2010"
                        "volumen" => "62"
                        "paginaInicial" => "1067"
                        "paginaFinal" => "1069"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept as prophylactic psoriatic therapy before interferon-alpha and ribavirin treatment for active hepatitis C infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;E&#46; Behnam"
                            1 => "R&#46; Hindiyeh"
                            2 => "D&#46;J&#46; Fife"
                            3 => "E&#46;W&#46; Jeffes 3rd"
                            4 => "J&#46;J&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2230.2009.03476.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Dermatol"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "397"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19663835"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept therapy in patients with psoriasis and concomitant HCV infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Garavaglia"
                            1 => "G&#46; Altomare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Immunopathol Pharmacol"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "965"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20943071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept in the treatment of psoriasis and psoriatic arthritis with concomitant hepatitis C virus infection&#58; clinical and virological study in three patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Zanni"
                            1 => "G&#46; Missale"
                            2 => "D&#46; Santilli"
                            3 => "S&#46; Di Nuzzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful clearance of hepatitis C virus with pegylated interferon &#945;-2a and ribavirin in an etanercept-treated patient with psoriatic arthritis&#44; hepatitis B virus coinfection and latent tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Mederacke"
                            1 => "T&#46; Witte"
                            2 => "H&#46; Wedemeyer"
                            3 => "D&#46; Meyer-Olson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.139824"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "1343"
                        "paginaFinal" => "1344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21131645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrahepatic expression of pro-inflammatory cytokine mRNAs and interferon efficacy in chronic hepatitis C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Fukuda"
                            1 => "N&#46; Ishimura"
                            2 => "S&#46; Ishihara"
                            3 => "A&#46; Chowdhury"
                            4 => "N&#46; Morlyama"
                            5 => "C&#46; Nogami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Liver"
                        "fecha" => "1996"
                        "volumen" => "16"
                        "paginaInicial" => "390"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9021719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor necrosis factor alpha gene expression and the response to interferon in chronic hepatitis C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Larrea"
                            1 => "N&#46; Garcia"
                            2 => "C&#46; Qian"
                            3 => "M&#46;P&#46; Civeira"
                            4 => "J&#46; Prieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.510230203"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "1996"
                        "volumen" => "23"
                        "paginaInicial" => "210"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8591843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept as an adjuvant to interferon and ribavirin in treatment-naive patients with chronic hepatitis C virus infection&#58; a phase 2 randomized&#44; double-blind&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Etanercept Study Group"
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;N&#46; Zein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2005"
                        "volumen" => "42"
                        "paginaInicial" => "315"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15791697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EASL Clinical Practice Guidelines&#58; Management of hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "European Association for the Study of the Liver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2011.02.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2011"
                        "volumen" => "55"
                        "paginaInicial" => "245"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21371579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000383/v1_201304241622/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6259"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000003/v1_201304241622/S1578219013000383/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000383?idApp=UINPBA000044"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case Report
Acute Hepatitis C in a Patient Receiving Etanercept
Hepatitis C aguda en un paciente en tratamiento con etanercept
M. Armengot-Carbóa,
Autor para correspondencia
miquelarmengot@gmail.com

Corresponding author.
, M. Velascoa, R. Ginerb, E. Gimenoa
a Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain
b Servicio de Medicina Digestiva, Hospital Arnau de Vilanova, Valencia, Spain
Leído
5931
Veces
se ha leído el artículo
2066
Total PDF
3865
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S1578219013000383"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2013-04-01"
  "aid" => "577"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "Actas Dermosifiliogr. 2013;104:239-41"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2194
    "formatos" => array:3 [
      "EPUB" => 46
      "HTML" => 1657
      "PDF" => 491
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S000173101200110X"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2011.08.014"
      "estado" => "S300"
      "fechaPublicacion" => "2013-04-01"
      "aid" => "577"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "sco"
      "cita" => "Actas Dermosifiliogr. 2013;104:239-41"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4090
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 2400
          "PDF" => 1687
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Hepatitis C aguda en un paciente en tratamiento con etanercept"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "239"
            "paginaFinal" => "241"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Acute Hepatitis C in a Patient Receiving Etanercept"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 563
                "Ancho" => 950
                "Tamanyo" => 139915
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Placas eritematodescamativas generalizadas previas al inicio del tratamiento con etanercept&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Armengot-Carb&#243;, M&#46; Velasco, R&#46; Giner, E&#46; Gimeno"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Armengot-Carb&#243;"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Velasco"
              ]
              2 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Giner"
              ]
              3 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Gimeno"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219013000383"
          "doi" => "10.1016/j.adengl.2011.08.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000383?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101200110X?idApp=UINPBA000044"
      "url" => "/00017310/0000010400000003/v1_201304241344/S000173101200110X/v1_201304241344/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219013000395"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.02.009"
    "estado" => "S300"
    "fechaPublicacion" => "2013-04-01"
    "aid" => "601"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Actas Dermosifiliogr. 2013;104:242-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5282
      "formatos" => array:3 [
        "EPUB" => 57
        "HTML" => 3806
        "PDF" => 1419
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Disseminated Juvenile Xanthogranuloma Associated With Follicular Lymphoma in an Adult&#58; Successful Treatment With Chemotherapy and Rituximab&#46; A Review of the Literature"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "242"
          "paginaFinal" => "246"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Xantogranuloma juvenil diseminado del adulto asociado a linfoma folicular&#44; respuesta completa a quimioterapia y rituximab&#46; Revisi&#243;n de la literatura"
        ]
      ]
      "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" => 1565
              "Ancho" => 1655
              "Tamanyo" => 562382
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A&#44; Infiltrate composed of cells with abundant cytoplasm and a histiocytic appearance&#44; some multinucleated giant cells&#44; lymphocytes with no atypia&#44; and a few eosinophils &#40;hematoxylin-eosin&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; B&#44; Immunohistochemistry showing a negative result for CD1a &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>200&#41;&#46; C&#44; Immunohistochemistry showing granular positivity for CD68 in the cellular cytoplasm &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>200&#41;&#46; D&#44; Histology of inguinal lymph node showing a lymphoid proliferation of centrocytes &#40;small cleaved cells&#41; &#40;original magnification<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "B&#46; Narv&#225;ez-Moreno, &#193;&#46; Pulpillo-Ruiz, T&#46; De Zulueta-Dorado, J&#46; Conejo-Mir"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Narv&#225;ez-Moreno"
            ]
            1 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Pulpillo-Ruiz"
            ]
            2 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "De Zulueta-Dorado"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Conejo-Mir"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731012001585"
        "doi" => "10.1016/j.ad.2012.02.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012001585?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000395?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000395/v1_201304241622/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219013000371"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2012.10.008"
    "estado" => "S300"
    "fechaPublicacion" => "2013-04-01"
    "aid" => "764"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2013;104:232-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3662
      "formatos" => array:3 [
        "EPUB" => 43
        "HTML" => 2625
        "PDF" => 994
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prevalence of Antiphospholipid Antibodies in Patients With Subacute and Chronic Cutaneous Lupus Erythematosus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "232"
          "paginaFinal" => "238"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia de anticuerpos antifosfolipido en pacientes con lupus eritematoso cut&#225;neo subagudo y cr&#243;nico"
        ]
      ]
      "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" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2170
              "Ancho" => 3170
              "Tamanyo" => 350440
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm&#46; Abbreviations&#58; CLE indicates cutaneous lupus erythematosus&#59; SLE&#44; systemic lupus erythematosus&#59; ANA&#44; antinuclear antibodies&#59; aPTT&#44; activated partial thromboplastin time&#59; LA&#44; lupus anticoagulant&#59; ACA&#44; anticardiolipin antibodies&#59; anti-&#946;<span class="elsevierStyleInf">2</span>GPI&#44; anti-&#946;<span class="elsevierStyleInf">2</span>-glycoprotein I&#59; APS&#44; antiphospholipid syndrome&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Garc&#237;a-Mart&#237;n, C&#46; Garc&#237;a-Garc&#237;a, J&#46; Fraga, A&#46; Garc&#237;a-D&#237;ez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Garc&#237;a-Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Garc&#237;a-Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Fraga"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-D&#237;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101200539X"
        "doi" => "10.1016/j.ad.2012.10.017"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101200539X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000371?idApp=UINPBA000044"
    "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000371/v1_201304241622/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Acute Hepatitis C in a Patient Receiving Etanercept"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "239"
        "paginaFinal" => "241"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Armengot-Carb&#243;, M&#46; Velasco, R&#46; Giner, E&#46; Gimeno"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Armengot-Carb&#243;"
            "email" => array:1 [
              0 => "miquelarmengot&#64;gmail&#46;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" => "M&#46;"
            "apellidos" => "Velasco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Giner"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Gimeno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Arnau de Vilanova&#44; Valencia&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Digestiva&#44; Hospital Arnau de Vilanova&#44; Valencia&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hepatitis C aguda en un paciente en tratamiento con etanercept"
      ]
    ]
    "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" => 938
            "Ancho" => 1585
            "Tamanyo" => 222383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Widespread desquamating erythematous plaques prior to the onset of treatment with etanercept&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tumor necrosis factor &#40;TNF&#41; antagonists have been used to treat a variety of conditions in patients with chronic hepatitis C virus &#40;HCV&#41; infection&#44; as shown by numerous case reports in the literature&#46; However&#44; we have found no reports of primary HCV infection that occurred after treatment with an anti-TNF biologic had been started&#46; We present such a case of primary HCV infection that occurred while the patient was on etanercept for psoriasis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old man with a history of smoking and anxiety had long-standing moderate-severe psoriasis that had been treated with corticosteroids and vitamin D analogs since 1999&#46; In 2005 our department prescribed treatment with methotrexate at a weekly dose of 15<span class="elsevierStyleHsp" style=""></span>mg&#46; Response was good&#46; However&#44; symptoms worsened after 6 months&#44; when a psoriasis area and severity index &#40;PASI&#41; of 23 was reached &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The advisability of treating this particular patient with a biologic agent was then considered&#46; The pretreatment complete blood count and biochemistry showed normal values&#44; and a chest radiograph was unremarkable&#46; A tuberculin skin test and serology for HBV&#44; HCV&#44; and the human immunodeficiency virus were negative&#46; Treatment with etanercept was begun in 2006 with the usual regimen of 50<span class="elsevierStyleHsp" style=""></span>mg twice weekly for 3 months and followed with once-weekly administration thereafter&#46; PASI 0 was reached after 6 months&#46; Several relapses occurred between 2006 and 2009 on withdrawal of etanercept&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">While the patient was on etanercept in 2009&#44; elevated transaminase levels were detected on routine testing &#40;alanine aminotransferase&#44; 710<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#59; aspartate aminotransferase&#44; 647<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#41;&#46; When the blood tests and viral serology were repeated&#44; elevated liver enzyme levels were confirmed and HCV seroconversion was revealed&#46; The patient was referred to the gastroenterology department&#44; where complementary tests were ordered&#46; The diagnosis was acute HCV infection &#40;viral load<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10 million copies&#47;mL&#44; genotype 1a&#41;&#46; The patient reported not having received transfusions or undergone surgery recently&#46; He denied parenteral drug use and high-risk sexual activities&#46; The probable source of contact was judged to be his wife&#44; who was found to harbor HCV&#46; This chronic infection had not been diagnosed before her husband&#39;s acute infection led to testing&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Etanercept treatment was not interrupted&#46; Given the patient&#39;s progressively increasing transaminase levels and viral load&#44; pegylated interferon-alpha was prescribed in November 2009&#46; Transaminase levels and viral load responded rapidly&#44; but worsening psoriasis symptoms were an expected effect of the interferon treatment&#46; A higher etanercept dose &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;wk&#41; achieved partial response&#46; The antiviral treatment was continued for 24 weeks&#44; and sustained viral response was confirmed at the time of writing&#44; The higher dose of etanercept was used throughout the duration of interferon treatment and in the month after antiviral therapy was stopped&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">TNF&#44; a proinflammatory cytokine secreted by monocytes and macrophages&#44; is implicated in the immune response to infections&#46; Treatment with anti-TNF agents therefore increases the likelihood that latent bacterial &#40;e&#46;g&#46;&#44; mycobacterial&#41; or fungal infections will be reactivated&#46; However&#44; the effect of these agents on viral infections is less well understood&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In hepatitis viral infection&#44; elevated liver and serum levels of TNF and TNF receptors have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> In HBV infection&#44; TNF plays a key role in controlling viral replication&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; elevated levels of this cytokine are associated with greater hepatocellular damage in HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> TNF also appears to be implicated in the pathogenesis of fibrosis of the liver&#44; which leads to cirrhosis in 20&#37; of HCV-infected patients over a period of 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Anti-TNF agents might therefore even prove beneficial for some of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> In our patient&#44; treatment with etanercept may have attenuated liver damage secondary to the primary acute HCV infection&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the possible adverse effect of anti-TNF agents on viral load or disease progression&#44; relevant information can be inferred from reports of more than 80 cases involving chronically HCV-infected patients under such treatment &#40;particularly with etanercept&#41; for a variety of autoimmune diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> The absence of significant changes in viral load and transaminase levels is a striking observation in these cases&#46; Paradisi and coworkers<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> recently reported the results of liver biopsy at baseline and after 12 months of etanercept treatment in 2 HCV-infected patients with psoriasis&#44; observing no progression of liver damage&#46; The use of anti-TNF agents in patients with chronic HCV infection therefore seems to be safe based on existing evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> However&#44; we were unable to find published cases like the one we report&#44; in which acute HCV infection occurred during anti-TNF treatment&#46; Our patient&#39;s course suggests that continuing etanercept in a primary infection like this one will not have an adverse effect on disease progression or the response to interferon&#44; although further confirmation is required&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Elevated TNF levels potentially also interfere with the response to antiviral treatment in HCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> In a small double-blind&#44; randomized placebo-controlled trial that assessed the possibility that etanercept might boost the effect of interferon&#8211;ribavirin treatment of chronic HCV infection&#44; the authors reported that the negativization of viral load was significantly greater in the etanercept group &#40;63&#37;&#41; than in the placebo group &#40;32&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In the case we report&#44; it is possible that in addition to a lack of an adverse effect of continued etanercept administration on the efficacy of the antiviral regimen&#44; etanercept may even have assisted HCV-RNA negativization&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; the fact that transmission in this case was by heterosexual contact suggests that even though clinical guidelines state that risk is low for this route&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> treatment with a biologic might increase the risk&#46; Evidently&#44; an exhaustive medical history should be taken for all patients on these drugs&#46; Candidates for anti-TNF therapy are screened for contact with tuberculosis&#46; It might also be useful to investigate the possibility of exposure to other diseases&#44; especially through contact with relatives or other persons who live with the patient&#44; so that we are not taken by surprise by infections that might compromise our patients&#8217; safety during treatment&#46; HBV vaccination is also necessary for patients with negative HBV serology in order to guard against primary infection during treatment with a biologic agent&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This is the first report of a case of primary HCV infection during a period of anti-TNF therapy&#46; The course of disease in our patient suggests that it is safe to maintain etanercept treatment in cases of acute HCV infection&#46; Just as etanercept does not have an adverse effect on the treatment of chronic infection&#44; there seems to be no interference in acute infection either&#46; This observation should be confirmed in larger series&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dr M&#46; Armengot-Carb&#243; has an agreement with Pfizer to collaborate on another publication&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Dr M&#46; Velasco and Dr E&#46; Gimeno have participated in clinical trials&#44; provided consulting services&#44; received speaking fees&#44; or accepted funding to attend conferences or training sessions from the following laboratories&#58; Pfizer&#44; Abbott&#44; and Janssen-Cilag&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dr R&#46; Giner declares that she has no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:2 [
          "identificador" => "xres97883"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec85038"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres97882"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec85039"
          "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" => "2011-06-28"
    "fechaAceptado" => "2011-08-27"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec85038"
          "palabras" => array:4 [
            0 => "Hepatitis C"
            1 => "Etanercept"
            2 => "TNF inhibitors"
            3 => "Psoriasis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec85039"
          "palabras" => array:4 [
            0 => "Hepatitis C"
            1 => "Etanercept"
            2 => "Antagonistas del TNF alfa"
            3 => "Psoriasis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">According to the literature&#44; the use of tumor necrosis factor &#40;TNF&#41; inhibitors in patients with chronic hepatitis C infection is safe and effective&#46; There have been no reports&#44; however&#44; of primary infection with the hepatitis C virus during treatment with a biologic agent&#46; We report the case of a patient with long-standing moderate to severe psoriasis who developed acute hepatitis C while being treated with etanercept&#46; Biologic therapy was continued and the infection was successfully treated with pegylated interferon&#44; which achieved a sustained virologic response&#46; Etanercept did not have a negative impact on disease outcome or on response to antiviral treatment&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El uso de agentes bloqueadores del factor de necrosis tumoral alfa &#40;anti-TNF&#945;&#41; en pacientes con hepatitis C cr&#243;nica ha sido descrito en la literatura en su conjunto como seguro y eficaz&#46; Sin embargo&#44; no se han descrito hasta la fecha casos de primoinfecci&#243;n por el virus de la hepatitis C ocurridos durante el tratamiento con un biol&#243;gico&#46; Presentamos un paciente con psoriasis moderada-severa de larga evoluci&#243;n que&#44; estando en tratamiento con etanercept&#44; sufri&#243; una hepatitis C aguda&#46; Sin suspender el f&#225;rmaco anti-TNF&#945; recibi&#243; tratamiento con interfer&#243;n pegilado&#44; con respuesta virol&#243;gica sostenida&#46; Etanercept no interfiri&#243; de forma negativa en la evoluci&#243;n de la enfermedad ni en la respuesta al tratamiento antiviral&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Armengot-Carb&#243; M&#44; et al&#46; Hepatitis C aguda en un paciente en tratamiento con etanercept&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;239&#8211;41&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 938
            "Ancho" => 1585
            "Tamanyo" => 222383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Widespread desquamating erythematous plaques prior to the onset of treatment with etanercept&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept e infecci&#243;n cr&#243;nica por los virus de la hepatitis C y B"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "X&#46; Bordas"
                            1 => "S&#46; Mart&#237;n-Sala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "82"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20492886"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642007003429"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Afectaci&#243;n hep&#225;tica biol&#243;gica en el tratamiento de la psoriasis&#46; Consideraciones pr&#225;cticas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Llamas-Velasco"
                            1 => "R&#46; Navarro"
                            2 => "M&#46;J&#46; Concha"
                            3 => "E&#46; Daud&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of psoriasis and psoriatic arthritis&#58; Section 1&#46; Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Menter"
                            1 => "A&#46; Gottlieb"
                            2 => "S&#46;R&#46; Feldman"
                            3 => "A&#46;S&#46; Van Voorhees"
                            4 => "C&#46;L&#46; Leonardi"
                            5 => "K&#46;B&#46; Gordon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2008.02.039"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2008"
                        "volumen" => "58"
                        "paginaInicial" => "826"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18423260"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002939410001157"
                          "estado" => "S300"
                          "issn" => "00029394"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumour necrosis factor-&#945; antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C&#58; a retrospective analysis of 17 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Prignano"
                            1 => "F&#46; Ricceri"
                            2 => "L&#46; Pescitelli"
                            3 => "F&#46; Zanieri"
                            4 => "T&#46; Lotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2010.10140.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "164"
                        "paginaInicial" => "645"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21375517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of etanercept in patients with psoriasis and hepatitis C virus assessed by liver histopathology&#58; preliminary data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Paradisi"
                            1 => "G&#46; Caldarola"
                            2 => "R&#46; Capizzi"
                            3 => "M&#46; Siciliano"
                            4 => "E&#46; Annichiarico"
                            5 => "F&#46;M&#46; Vecchio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2009.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2010"
                        "volumen" => "62"
                        "paginaInicial" => "1067"
                        "paginaFinal" => "1069"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept as prophylactic psoriatic therapy before interferon-alpha and ribavirin treatment for active hepatitis C infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;E&#46; Behnam"
                            1 => "R&#46; Hindiyeh"
                            2 => "D&#46;J&#46; Fife"
                            3 => "E&#46;W&#46; Jeffes 3rd"
                            4 => "J&#46;J&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2230.2009.03476.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Dermatol"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "397"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19663835"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept therapy in patients with psoriasis and concomitant HCV infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Garavaglia"
                            1 => "G&#46; Altomare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Immunopathol Pharmacol"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "965"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20943071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept in the treatment of psoriasis and psoriatic arthritis with concomitant hepatitis C virus infection&#58; clinical and virological study in three patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Zanni"
                            1 => "G&#46; Missale"
                            2 => "D&#46; Santilli"
                            3 => "S&#46; Di Nuzzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful clearance of hepatitis C virus with pegylated interferon &#945;-2a and ribavirin in an etanercept-treated patient with psoriatic arthritis&#44; hepatitis B virus coinfection and latent tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Mederacke"
                            1 => "T&#46; Witte"
                            2 => "H&#46; Wedemeyer"
                            3 => "D&#46; Meyer-Olson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.139824"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
                        "paginaInicial" => "1343"
                        "paginaFinal" => "1344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21131645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrahepatic expression of pro-inflammatory cytokine mRNAs and interferon efficacy in chronic hepatitis C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Fukuda"
                            1 => "N&#46; Ishimura"
                            2 => "S&#46; Ishihara"
                            3 => "A&#46; Chowdhury"
                            4 => "N&#46; Morlyama"
                            5 => "C&#46; Nogami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Liver"
                        "fecha" => "1996"
                        "volumen" => "16"
                        "paginaInicial" => "390"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9021719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor necrosis factor alpha gene expression and the response to interferon in chronic hepatitis C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Larrea"
                            1 => "N&#46; Garcia"
                            2 => "C&#46; Qian"
                            3 => "M&#46;P&#46; Civeira"
                            4 => "J&#46; Prieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.510230203"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "1996"
                        "volumen" => "23"
                        "paginaInicial" => "210"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8591843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etanercept as an adjuvant to interferon and ribavirin in treatment-naive patients with chronic hepatitis C virus infection&#58; a phase 2 randomized&#44; double-blind&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Etanercept Study Group"
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;N&#46; Zein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2005"
                        "volumen" => "42"
                        "paginaInicial" => "315"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15791697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EASL Clinical Practice Guidelines&#58; Management of hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "European Association for the Study of the Liver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2011.02.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2011"
                        "volumen" => "55"
                        "paginaInicial" => "245"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21371579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000383/v1_201304241622/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6259"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000003/v1_201304241622/S1578219013000383/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000383?idApp=UINPBA000044"
]
Información del artículo
ISSN: 15782190
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 11 4 15
2024 Octubre 64 34 98
2024 Septiembre 65 22 87
2024 Agosto 89 61 150
2024 Julio 50 26 76
2024 Junio 71 34 105
2024 Mayo 59 30 89
2024 Abril 57 23 80
2024 Marzo 56 32 88
2024 Febrero 43 28 71
2024 Enero 43 35 78
2023 Diciembre 47 18 65
2023 Noviembre 52 24 76
2023 Octubre 64 23 87
2023 Septiembre 55 31 86
2023 Agosto 37 11 48
2023 Julio 28 40 68
2023 Junio 49 20 69
2023 Mayo 40 20 60
2023 Abril 37 18 55
2023 Marzo 35 19 54
2023 Febrero 42 17 59
2023 Enero 25 27 52
2022 Diciembre 39 46 85
2022 Noviembre 18 29 47
2022 Octubre 24 22 46
2022 Septiembre 22 36 58
2022 Agosto 19 35 54
2022 Julio 25 32 57
2022 Junio 22 26 48
2022 Mayo 35 31 66
2022 Abril 36 30 66
2022 Marzo 42 43 85
2022 Febrero 33 22 55
2022 Enero 32 35 67
2021 Diciembre 24 39 63
2021 Noviembre 38 35 73
2021 Octubre 33 50 83
2021 Septiembre 29 41 70
2021 Agosto 27 26 53
2021 Julio 29 35 64
2021 Junio 24 37 61
2021 Mayo 28 24 52
2021 Abril 40 71 111
2021 Marzo 67 31 98
2021 Febrero 45 35 80
2021 Enero 37 19 56
2020 Diciembre 28 11 39
2020 Noviembre 21 22 43
2020 Octubre 23 14 37
2020 Septiembre 28 11 39
2020 Agosto 28 16 44
2020 Julio 25 13 38
2020 Junio 42 18 60
2020 Mayo 43 11 54
2020 Abril 42 18 60
2020 Marzo 39 14 53
2020 Febrero 5 0 5
2020 Enero 4 2 6
2019 Diciembre 8 5 13
2019 Noviembre 4 0 4
2019 Septiembre 5 1 6
2019 Agosto 4 0 4
2019 Julio 4 0 4
2019 Junio 5 12 17
2019 Mayo 6 25 31
2019 Abril 2 1 3
2019 Marzo 4 11 15
2019 Febrero 0 1 1
2019 Enero 2 0 2
2018 Diciembre 2 0 2
2018 Noviembre 1 0 1
2018 Octubre 3 0 3
2018 Septiembre 2 0 2
2018 Marzo 1 1 2
2018 Febrero 33 4 37
2018 Enero 38 10 48
2017 Diciembre 33 5 38
2017 Noviembre 33 4 37
2017 Octubre 38 4 42
2017 Septiembre 50 5 55
2017 Agosto 77 5 82
2017 Julio 63 4 67
2017 Junio 77 6 83
2017 Mayo 65 7 72
2017 Abril 50 7 57
2017 Marzo 34 1 35
2017 Febrero 33 12 45
2017 Enero 27 8 35
2016 Diciembre 36 4 40
2016 Noviembre 44 7 51
2016 Octubre 67 18 85
2016 Septiembre 62 10 72
2016 Agosto 52 7 59
2016 Julio 29 6 35
2016 Junio 11 0 11
2016 Mayo 5 6 11
2016 Abril 13 1 14
2016 Marzo 4 1 5
2016 Febrero 13 1 14
2016 Enero 8 1 9
2015 Diciembre 5 0 5
2015 Noviembre 11 1 12
2015 Octubre 7 3 10
2015 Septiembre 5 1 6
2015 Agosto 20 5 25
2015 Julio 64 114 178
2015 Junio 51 12 63
2015 Mayo 61 9 70
2015 Abril 45 8 53
2015 Marzo 8 5 13
2015 Febrero 14 2 16
2015 Enero 10 1 11
2014 Diciembre 14 5 19
2014 Noviembre 5 5 10
2014 Octubre 16 9 25
2014 Septiembre 10 5 15
2014 Agosto 9 7 16
2014 Julio 7 5 12
2014 Junio 19 5 24
2014 Mayo 21 7 28
2014 Abril 24 5 29
2014 Marzo 25 6 31
2014 Febrero 38 9 47
2014 Enero 19 8 27
2013 Diciembre 31 10 41
2013 Noviembre 18 7 25
2013 Octubre 14 2 16
2013 Septiembre 12 3 15
2013 Agosto 8 8 16
2013 Julio 4 8 12
2013 Junio 2 4 6
2013 Mayo 2 3 5
2013 Abril 3 6 9
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?