Case and Research Letters
Pulmonary and Lymph Node Sarcoidosis Associated With Anti-Tumor Necrosis Factor Therapy in a Patient With Psoriasis: A New Case of This Paradoxical Phenomenon
Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico
L. Padilla-España
, S. Habicheyn-Hiar, M. de Troya
Autor para correspondencia
Servicio de Dermatología, Hospital Costa del Sol, Marbella, Spain
Leído
5673
Vecesse ha leído el artículo
2242
Total PDF
3431
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S157821901500253X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.09.018" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1185" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2015;106:760-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 935 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 464 "PDF" => 419 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S000173101500215X" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.03.011" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1185" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2015;106:760-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 651 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 351 "PDF" => 298 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "760" "paginaFinal" => "762" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary and Lymph Node Sarcoidosis Associated With Anti-Tumor Necrosis Factor Therapy in a Patient With Psoriasis: A New Case of This Paradoxical Phenomenon" ] ] "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" => 975 "Ancho" => 975 "Tamanyo" => 136999 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Múltiples nódulos en mediastino y ambos hilios en disposición en conglomerado y en fosa supraclavicular izquierda así como afectación pulmonar nodular en corte transversal de TAC de alta resolución.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Padilla-España, S. Habicheyn-Hiar, M. de Troya" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Padilla-España" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Habicheyn-Hiar" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "de Troya" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901500253X" "doi" => "10.1016/j.adengl.2015.09.018" "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/S157821901500253X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101500215X?idApp=UINPBA000044" "url" => "/00017310/0000010600000009/v1_201511040159/S000173101500215X/v1_201511040159/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219015002528" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.09.017" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1186" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:762-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2097 "formatos" => array:3 [ "EPUB" => 36 "HTML" => 599 "PDF" => 1462 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Vitamin B12 Deficiency and its Numerous Skin Manifestations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "762" "paginaFinal" => "764" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Déficit de vitamina B12 y sus diversas manifestaciones dermatológicas" ] ] "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" => 748 "Ancho" => 1000 "Tamanyo" => 116277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple hyperpigmented macules on the palm of the left hand.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Vera-Kellet, R. Andino-Navarrete, L. Navajas-Galimany" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Vera-Kellet" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Andino-Navarrete" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Navajas-Galimany" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002161" "doi" => "10.1016/j.ad.2015.03.012" "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/S0001731015002161?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002528?idApp=UINPBA000044" "url" => "/15782190/0000010600000009/v1_201511040157/S1578219015002528/v1_201511040157/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219015002589" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.09.023" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "1155" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2015;106:759" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2036 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 1442 "PDF" => 539 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Treatment of Harlequin Ichthyosis With Acitretin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "759" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ictiosis arlequín tratada con acitretino" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 2167 "Tamanyo" => 431324 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Arjona-Aguilera, C. Albarrán-Planelles, D. Jiménez-Gallo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Arjona-Aguilera" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Albarrán-Planelles" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015001490" "doi" => "10.1016/j.ad.2015.03.003" "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/S0001731015001490?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002589?idApp=UINPBA000044" "url" => "/15782190/0000010600000009/v1_201511040157/S1578219015002589/v1_201511040157/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Pulmonary and Lymph Node Sarcoidosis Associated With Anti-Tumor Necrosis Factor Therapy in a Patient With Psoriasis: A New Case of This Paradoxical Phenomenon" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "760" "paginaFinal" => "762" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Padilla-España, S. Habicheyn-Hiar, M. de Troya" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:1 [ 0 => "laupadesp@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Habicheyn-Hiar" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "de Troya" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico" ] ] "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" => 975 "Ancho" => 975 "Tamanyo" => 142482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography, axial cuts: Multiple nodules forming masses were observed in the mediastinum, at both hila, and in the left supraclavicular fossa, in addition to nodular pulmonary involvement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 43-year-old man with a history of mild perinatal anoxic encephalopathy, obesity since childhood, and severe plaque psoriasis diagnosed at 28 years of age, not controlled by topical treatments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Prior to starting systemic treatment, the patient presented multiple infiltrated and desquamating erythematous plaques, particularly affecting the lumbosacral region and legs, with a psoriasis area severity index (PASI)<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>15. However, there was no nail or joint involvement. Given the patient's degree of dependence and the lack of response to previous systemic treatments with acitretin and methotrexate, it was decided to start biological therapy, and additional tests were therefore requested, including complete blood count, biochemistry, urinary sediment, chest x-ray, and a tuberculin test, all of which were negative or normal. Treatment was then started with etanercept 50<span class="elsevierStyleHsp" style=""></span>mg administered subcutaneously once a week, after performing the induction course, obtaining a good clinical response and achieving a PASI of 75% at 10 weeks.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite normal laboratory results during the anti-tumor necrosis factor (TNF) therapy and for 2 years of follow-up, a persistent moderate leucopenia was later detected in serial blood tests, and a chest x-ray, serology, and evaluation by the hematology department were therefore requested. A detailed medical history did not detect associated systemic symptoms.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The chest x-ray revealed a parahilar mass consistent with the high-resolution computed tomography findings of multiple mediastinal, parahilar, and supraclavicular lymph nodes and multiple pulmonary nodules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Given the possibility of a lymphoproliferative disease, mediastinoscopy was performed to take a lymph node biopsy. Histology showed chronic noncaseating granulomatous inflammation with a negative Ziehl-Neelsen stain and negative polymerase chain reaction test for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Based on these findings, a diagnosis of pulmonary and lymph node sarcoidosis was made and the anti-TNF treatment was interrupted. Given the absence of respiratory symptoms, we took a conservative approach, with clinical and radiological follow-up of the patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Six months after withdrawing the anti-TNF treatment because of the diagnosis of sarcoidosis, we observed a radiological improvement (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) with a marked decrease in the size of the lymphadenopathies, and a complete blood count within normal limits.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The ever wider off-label use of anti-TNF drugs in the fields of rheumatology and dermatology and in autoinflammatory diseases in other specialist fields explains the increase in the incidence of paradoxical phenomena in recent years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> These are exacerbations or the new appearance of inflammatory conditions that usually respond to the use of anti-TNF therapy,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> such as psoriasiform rashes,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> uveitis, and the onset of other granulomatous diseases (Crohn disease and sarcoidosis). Controversy continues over the etiologic and pathogenic mechanisms underlying these phenomena, although it has been suggested that TNF inhibition may provoke a dysregulation of the compensatory proinflammatory cascade.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Fewer than 50 cases of pulmonary sarcoidosis induced by anti-TNF treatment have been reported in the literature, and the disease was only confirmed histologically in 27.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> The majority of cases have developed in patients with rheumatic inflammatory diseases, particularly rheumatoid arthritis (15%), followed by the spondyloarthropathies (7%) and psoriatic arthritis (4%). The most widely used TNF inhibitor was etanercept (52%), folowed by infliximab (30%) and adalimumab (18%). The diagnosis of sarcoidosis was made after a mean treatment duration of 23 months.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In all cases the treatment was interrupted and glucocorticoid therapy was administered in half of the patients; the clinical course of the sarcoidosis was satisfactory, with complete resolution in the majority of cases (89%).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of pulmonary sarcoidosis in patients treated with TNF inhibitors for psoriasis without joint involvement is rarer or, at least, it has not been reported as frequently in the literature. Ours is the second reported case induced by etanercept.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Differences in dosage and the follow-up of patients on TNF inhibitor treatment in rheumatology compared with those with exclusively cutaneous pathology could be the reason for this difference.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the etiological and pathogenic mechanisms remain unclear, it has been suggested that TNF inhibition could alter the expression of certain cytokines, such as interleukin (IL) 2, IL-18, and interferon-γ. Although all anti-TNF drugs act by blocking this proinflammatory cytokine, there are major differences both in their structure and in their pharmacokinetic and pharmacodynamic characteristics. The higher incidence of sarcoidosis with etanercept compared with other anti-TNF agents may be because this drug shows binding limited to transmembrane TNF, leaving the monomeric soluble form unbound, and it does not cause cell lysis, meaning that TNF inhibition would not be sufficient to prevent the formation of granulomas.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Ever more dermatologic diseases may benefit from the use of anti-TNF agents; the disease that has typically been described is psoriasis,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but the efficacy of this agent has recently been reported in other inflammatory diseases such as hidradenitis suppurativa and pyoderma gangrenosum. Paradoxical phenomena, in particular sarcoidosis, have been appearing with increasing frequency during treatment with anti-TNF agents, and dermatologists must therefore take this possible complication into account and ensure early recognition.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Padilla-España L, Habicheyn-Hiar S, de Troya M. Sarcoidosis pulmonar y ganglionar en un paciente con psoriasis durante terapia anti-TNF alfa: nuevo caso de fenómeno paradójico. Actas Dermosifiliogr. 2015;106:760–762.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 142482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography, axial cuts: Multiple nodules forming masses were observed in the mediastinum, at both hila, and in the left supraclavicular fossa, in addition to nodular pulmonary involvement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 257153 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Noncaseating chronic granulomatous inflammation in the transbronchial biopsy. Hematoxylin-eosin, original magnification x200.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 975 "Ancho" => 975 "Tamanyo" => 100008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography showing a significant reduction in the pulmonary nodules and parahiliar lymph nodes 6 months after diagnosis and the interruption of anti-TNF treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Tong" 1 => "N. Manolios" 2 => "G. Howe" 3 => "D. Spencer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med J." "fecha" => "2012" "volumen" => "42" "paginaInicial" => "89" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389903" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of cutaneous sarcoidosis during treatment with tumour necrosis alpha factor antagonists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Lamrock" 1 => "P. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-0960.2011.00845.x" "Revista" => array:6 [ "tituloSerie" => "Australas J Dermatol." "fecha" => "2012" "volumen" => "53" "paginaInicial" => "87" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22571555" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ustekinumab treatment of TNF antagonist-induced paradoxical psoriasis flare in a patient with psoriatic arthritis: case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Puig" 1 => "C.E. Morales-Múnera" 2 => "A. López-Ferrer" 3 => "C. Geli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000339864" "Revista" => array:6 [ "tituloSerie" => "Dermatology." "fecha" => "2012" "volumen" => "225" "paginaInicial" => "14" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22890275" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etanercept-induced cutaneous and pulmonary sarcoid-like granulomas resolving with adalimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Burns" 1 => "P.J. Green" 2 => "S. Pasternak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2011.01795.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol." "fecha" => "2012" "volumen" => "39" "paginaInicial" => "289" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21899592" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of sarcoidosis on antitumour necrosis factor therapy: a paradox" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Pink" 1 => "A. Fonia" 2 => "C.H. Smith" 3 => "J.N. Barker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2010.09843.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2010" "volumen" => "163" "paginaInicial" => "648" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20456350" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung sarcoidosis induced by TNF antagonists in rheumatoid arthritis: a case presentation and a literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Gifre" 1 => "V. Ruiz-Esquide" 2 => "A. Xaubet" 3 => "J.A. Gómez-Puerta" 4 => "M.V. Hernández" 5 => "R. Sanmartí" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2010.05.011" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2011" "volumen" => "47" "paginaInicial" => "208" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638761" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary sarcoidosis associated with etanercept therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.E. Farah" 1 => "M.D. Shay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1592/phco.27.10.1446" "Revista" => array:6 [ "tituloSerie" => "Pharmacotherapy." "fecha" => "2007" "volumen" => "27" "paginaInicial" => "1446" "paginaFinal" => "1448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17896899" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis as an adverse effect of tumor necrosis factor inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Cathcart" 1 => "N. Sami" 2 => "B. Elewski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol." "fecha" => "2012" "volumen" => "11" "paginaInicial" => "609" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22527429" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor necrosis factor and granuloma biology: explaining the differential infection risk of etanercept and infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. Wallis" 1 => "S. Ehlers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2005.01.009" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum." "fecha" => "2005" "volumen" => "34" "paginaInicial" => "34" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15852254" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of psoriasis in Spain in the age of biologics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Ferrándiz" 1 => "J.M. Carrascosa" 2 => "M. Toro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2013.12.008" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2014" "volumen" => "105" "paginaInicial" => "504" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569109" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000009/v1_201511040157/S157821901500253X/v1_201511040157/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000009/v1_201511040157/S157821901500253X/v1_201511040157/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901500253X?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 6 | 14 |
| 2024 Octubre | 89 | 38 | 127 |
| 2024 Septiembre | 101 | 20 | 121 |
| 2024 Agosto | 105 | 57 | 162 |
| 2024 Julio | 86 | 27 | 113 |
| 2024 Junio | 91 | 38 | 129 |
| 2024 Mayo | 76 | 25 | 101 |
| 2024 Abril | 71 | 27 | 98 |
| 2024 Marzo | 61 | 37 | 98 |
| 2024 Febrero | 63 | 31 | 94 |
| 2024 Enero | 61 | 39 | 100 |
| 2023 Diciembre | 63 | 20 | 83 |
| 2023 Noviembre | 71 | 24 | 95 |
| 2023 Octubre | 59 | 23 | 82 |
| 2023 Septiembre | 62 | 25 | 87 |
| 2023 Agosto | 49 | 22 | 71 |
| 2023 Julio | 58 | 36 | 94 |
| 2023 Junio | 68 | 34 | 102 |
| 2023 Mayo | 77 | 31 | 108 |
| 2023 Abril | 49 | 27 | 76 |
| 2023 Marzo | 47 | 30 | 77 |
| 2023 Febrero | 47 | 26 | 73 |
| 2023 Enero | 29 | 31 | 60 |
| 2022 Diciembre | 50 | 43 | 93 |
| 2022 Noviembre | 41 | 35 | 76 |
| 2022 Octubre | 24 | 21 | 45 |
| 2022 Septiembre | 16 | 35 | 51 |
| 2022 Agosto | 29 | 31 | 60 |
| 2022 Julio | 20 | 55 | 75 |
| 2022 Junio | 29 | 39 | 68 |
| 2022 Mayo | 52 | 34 | 86 |
| 2022 Abril | 63 | 45 | 108 |
| 2022 Marzo | 76 | 65 | 141 |
| 2022 Febrero | 55 | 29 | 84 |
| 2022 Enero | 65 | 38 | 103 |
| 2021 Diciembre | 39 | 29 | 68 |
| 2021 Noviembre | 58 | 54 | 112 |
| 2021 Octubre | 93 | 44 | 137 |
| 2021 Septiembre | 60 | 38 | 98 |
| 2021 Agosto | 76 | 17 | 93 |
| 2021 Julio | 28 | 32 | 60 |
| 2021 Junio | 34 | 45 | 79 |
| 2021 Mayo | 39 | 21 | 60 |
| 2021 Abril | 75 | 71 | 146 |
| 2021 Marzo | 58 | 22 | 80 |
| 2021 Febrero | 62 | 30 | 92 |
| 2021 Enero | 35 | 25 | 60 |
| 2020 Diciembre | 33 | 21 | 54 |
| 2020 Noviembre | 36 | 22 | 58 |
| 2020 Octubre | 43 | 23 | 66 |
| 2020 Septiembre | 26 | 17 | 43 |
| 2020 Agosto | 24 | 20 | 44 |
| 2020 Julio | 28 | 28 | 56 |
| 2020 Junio | 28 | 32 | 60 |
| 2020 Mayo | 28 | 35 | 63 |
| 2020 Abril | 25 | 19 | 44 |
| 2020 Marzo | 26 | 28 | 54 |
| 2020 Febrero | 3 | 14 | 17 |
| 2020 Enero | 4 | 13 | 17 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 3 | 2 | 5 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 0 | 4 | 4 |
| 2019 Julio | 4 | 18 | 22 |
| 2019 Junio | 0 | 22 | 22 |
| 2019 Mayo | 2 | 68 | 70 |
| 2019 Abril | 2 | 35 | 37 |
| 2019 Marzo | 0 | 16 | 16 |
| 2019 Febrero | 2 | 7 | 9 |
| 2019 Enero | 1 | 6 | 7 |
| 2018 Diciembre | 0 | 4 | 4 |
| 2018 Noviembre | 3 | 7 | 10 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 24 | 4 | 28 |
| 2018 Enero | 30 | 6 | 36 |
| 2017 Diciembre | 37 | 9 | 46 |
| 2017 Noviembre | 18 | 6 | 24 |
| 2017 Octubre | 27 | 3 | 30 |
| 2017 Septiembre | 31 | 7 | 38 |
| 2017 Agosto | 22 | 9 | 31 |
| 2017 Julio | 24 | 7 | 31 |
| 2017 Junio | 28 | 10 | 38 |
| 2017 Mayo | 31 | 10 | 41 |
| 2017 Abril | 28 | 8 | 36 |
| 2017 Marzo | 10 | 10 | 20 |
| 2017 Febrero | 15 | 10 | 25 |
| 2017 Enero | 11 | 6 | 17 |
| 2016 Diciembre | 23 | 17 | 40 |
| 2016 Noviembre | 40 | 23 | 63 |
| 2016 Octubre | 27 | 18 | 45 |
| 2016 Septiembre | 0 | 8 | 8 |
| 2016 Julio | 1 | 1 | 2 |
| 2016 Junio | 3 | 1 | 4 |
| 2016 Mayo | 2 | 5 | 7 |
| 2016 Abril | 0 | 6 | 6 |
| 2016 Marzo | 0 | 3 | 3 |
| 2016 Febrero | 0 | 1 | 1 |
| 2016 Enero | 0 | 4 | 4 |
| 2015 Diciembre | 0 | 2 | 2 |
| 2015 Noviembre | 0 | 6 | 6 |
Mostrar todo
