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"apellidos" => "Linares-Barrios" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101630165X" "doi" => "10.1016/j.ad.2016.04.022" "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/S000173101630165X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901630213X?idApp=UINPBA000044" "url" => "/15782190/0000010700000009/v1_201611010039/S157821901630213X/v1_201611010039/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016302189" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.08.015" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1442" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:781-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 965 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 690 "PDF" => 222 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Reactivation of Skin Lesions After Patch Testing to Investigate Drug Rash With Eosinophilia and Systemic Symptoms (DRESS) Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "783" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reactivación de las lesiones cutáneas por pruebas epicutáneas en el estudio de un síndrome de DRESS" ] ] "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" => 1125 "Ancho" => 750 "Tamanyo" => 165961 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lesions of lesser intensity similar to those of the previous rash. 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Plana-Pla, L. Pelegrín-Colás, I. Bielsa-Marsol, C. Ferrandiz-Foraster" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Plana-Pla" "email" => array:1 [ 0 => "adriplanapla@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Pelegrín-Colás" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Bielsa-Marsol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Ferrandiz-Foraster" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institut Clínic d’Oftalmología, Hospital Clínic de Barcelona, Barcelona, España" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clínica Badía, Mataró, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones orales y coriorretinitis placoide posterior como forma de presentación de sífilis secundaria en un paciente inmunocompetente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 632 "Ancho" => 1701 "Tamanyo" => 122501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A large, circular, yellowish placoid lesion on the pigmented epithelium of the retina, at the macula. B, Image after treatment, showing normalization of the retina.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Within the broad range of manifestations that syphilis can cause, lesions on the oral mucosa and eye involvement are very rare, particularly as isolated lesions. We describe a patient with oral lesions and eye involvement, with no associated skin lesions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 59-year-old man, with no past history of interest. He was referred from another center to investigate a 1-year history of oral mucosal symptoms presenting as odynophagia, a sensation of excess mucus secretion, and painful erosive lesions in the oral cavity and pharynx. The patient had also been seen in ophthalmology for a decrease in visual acuity over the previous 3 months.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed erosive lesions on the hard palate and on the right tonsillar pillar (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and difficulty swallowing. On ophthalmologic examination, a large, circular, yellowish placoid lesion was observed on the pigmented epithelium of the retina, at the macula. The lesion extended to the upper temporal vascular arches of the right eye (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2A</a>). Visual acuity was 20/50. This was initially considered as a chorioretinitis of uncertain origin. Biopsy of an oral lesion showed epidermal hyperplasia with a dense mixed inflammatory infiltrate with a predominance of plasma cells that extended into the deep dermis and was localized mainly around the blood vessels. Lymphocyte exocytosis was also observed. A provisional diagnosis of secondary syphilis was made, and staining with antitreponemal antibody showed the presence of numerous spirochetes in the mucosa and in smaller numbers in the submucosa. Syphilis serology in blood was positive (rapid plasma reagin, 1:128; treponema pallidum hemagglutination test, +). On further questioning, the patient denied previous skin lesions but did state that about 18 months earlier he had had an erosion on the glans that had been diagnosed as genital herpes at other center. Based on these findings, we made a diagnosis of posterior placoid chorioretinitis of probable syphilitic origin. HIV serology was negative and lumbar puncture showed a slight increase in the protein content of the cerebrospinal fluid (64<span class="elsevierStyleHsp" style=""></span>mg/dL), with normal cellularity and glucose levels and positive reagin antibodies titers (Venereal Disease Research Laboratory). A diagnosis was therefore made of secondary syphilis with central nervous system involvement (neurosyphilis) and the patient was treated with penicillin G sodium at a dose of 4 million IU intravenously every 4<span class="elsevierStyleHsp" style=""></span>hours for 14 days. The clinical course was favorable, with resolution of the oral lesions and a clear improvement in the ocular lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2B</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Syphilis can cause oral lesions in all of its stages, but they are most common in the secondary stage (30% of patients). However, the absence of concomitant skin manifestations, as in our case, is very rare.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The oral lesions of secondary syphilis are clinically very heterogeneous and typically nonspecific; they include macules, papules, plaques and ulcers, which may be single or multiple, and they are usually associated with nonspecific pharyngitis, tonsillitis, or laryngitis, sometimes with palpable lymph nodes.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> These lesions most frequently occur together with the typical cutaneous manifestations of the disease, and usually resolve within 3 to 12 weeks.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the present case, however, the lesions were isolated and persisted for at least a year. In a review of the literature, we found isolated case reports of oral lesions without associated skin manifestations,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> but none had a clinical course of more than 5 months in patients who, like ours, were immunocompetent.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Isolated lesions of syphilis on the oral mucosa are a considerable diagnostic challenge, and the histology of these lesions must therefore be carefully evaluated for any detail that will help to reach the diagnosis. In addition, the patient must be questioned closely about noncutaneous features of the disease, which must be investigated in detail as in the more common forms of the disease. Microscopy is often relatively nonspecific, but a recent article suggested that the presence of perivascular or perineural infiltrates of plasma cells and lymphocyte exocytosis could be signs that support the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In our case, the infiltrate of plasma cells was very dense and intense lymphocyte exocytosis was observed, leading us to suspect the diagnosis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The extracutaneous manifestations can be very varied. Eye involvement is one of the less common manifestations but, when it occurs, it usually develops during the secondary phase of the disease and it can affect any segment of the globe. Scleritis and uveitis are the most common forms of presentation, but keratitis and conjunctivitis can also develop.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a recently described ocular manifestation and is extremely rare in immunocompetent patients such as the patient we describe.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">ASPPC was first described in 1988 and, since that time, only 60 cases have been published, of which 40% were diagnosed in HIV-positive patients.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Clinically, ASPPC is characterized by the appearance of yellowish placoid lesions situated at the macula and there is a marked loss of visual acuity.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The search for extracutaneous manifestations, and for eye involvement in particular, is essential in these patients (especially if associated with immune compromise), as these alterations not only affect the prognosis of the disease but they are also of importance when choosing the treatment to be administered. The presence of syphilitic eye lesions, as in the present case, is diagnostic of neurosyphilis, making the patient a candidate for intravenous treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although the incidence of neurosyphilis is low in immunocompetent patients (0.2-2.1 cases per 100<span class="elsevierStyleHsp" style=""></span>000 population<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>) and that of syphilitic ocular involvement is even lower, the increase in the number of cases of syphilis in recent years in developed countries requires us to be aware of the most atypical and least common presentations of this disease as, when this is not diagnosed early, the infection can spread and the harm to the patient can increase.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Plana-Pla A, Pelegrín-Colás L, Bielsa-Marsol I, Ferrandiz-Foraster C. Lesiones orales y coriorretinitis placoide posterior como forma de presentación de sífilis secundaria en un paciente inmunocompetente. Actas Dermosifiliogr. 2016;107:783–784.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 115922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erosions on the hard palate and the right tonsillar pillar.</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" => 632 "Ancho" => 1701 "Tamanyo" => 122501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A large, circular, yellowish placoid lesion on the pigmented epithelium of the retina, at the macula. B, Image after treatment, showing normalization of the retina.</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" => "Oral manifestations of syphilis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. Leao" 1 => "L.A. Gueiros" 2 => "S.R. 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año/Mes | Html | Total | |
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2024 Noviembre | 15 | 21 | 36 |
2024 Octubre | 92 | 85 | 177 |
2024 Septiembre | 132 | 58 | 190 |
2024 Agosto | 141 | 86 | 227 |
2024 Julio | 94 | 76 | 170 |
2024 Junio | 126 | 60 | 186 |
2024 Mayo | 122 | 60 | 182 |
2024 Abril | 129 | 54 | 183 |
2024 Marzo | 191 | 35 | 226 |
2024 Febrero | 236 | 36 | 272 |
2024 Enero | 211 | 36 | 247 |
2023 Diciembre | 272 | 12 | 284 |
2023 Noviembre | 249 | 25 | 274 |
2023 Octubre | 262 | 24 | 286 |
2023 Septiembre | 253 | 26 | 279 |
2023 Agosto | 240 | 15 | 255 |
2023 Julio | 146 | 41 | 187 |
2023 Junio | 178 | 26 | 204 |
2023 Mayo | 328 | 26 | 354 |
2023 Abril | 223 | 21 | 244 |
2023 Marzo | 179 | 20 | 199 |
2023 Febrero | 153 | 28 | 181 |
2023 Enero | 162 | 29 | 191 |
2022 Diciembre | 176 | 40 | 216 |
2022 Noviembre | 151 | 29 | 180 |
2022 Octubre | 81 | 28 | 109 |
2022 Septiembre | 26 | 29 | 55 |
2022 Agosto | 22 | 26 | 48 |
2022 Julio | 74 | 27 | 101 |
2022 Junio | 138 | 18 | 156 |
2022 Mayo | 146 | 39 | 185 |
2022 Abril | 178 | 36 | 214 |
2022 Marzo | 145 | 39 | 184 |
2022 Febrero | 193 | 34 | 227 |
2022 Enero | 242 | 46 | 288 |
2021 Diciembre | 136 | 39 | 175 |
2021 Noviembre | 132 | 48 | 180 |
2021 Octubre | 134 | 63 | 197 |
2021 Septiembre | 112 | 43 | 155 |
2021 Agosto | 110 | 28 | 138 |
2021 Julio | 66 | 32 | 98 |
2021 Junio | 50 | 19 | 69 |
2021 Mayo | 42 | 44 | 86 |
2021 Abril | 87 | 72 | 159 |
2021 Marzo | 65 | 31 | 96 |
2021 Febrero | 39 | 27 | 66 |
2021 Enero | 28 | 17 | 45 |
2020 Diciembre | 32 | 16 | 48 |
2020 Noviembre | 29 | 38 | 67 |
2020 Octubre | 28 | 18 | 46 |
2020 Septiembre | 24 | 13 | 37 |
2020 Agosto | 22 | 17 | 39 |
2020 Julio | 22 | 11 | 33 |
2020 Junio | 24 | 28 | 52 |
2020 Mayo | 15 | 9 | 24 |
2020 Abril | 23 | 12 | 35 |
2020 Marzo | 28 | 12 | 40 |
2020 Febrero | 2 | 0 | 2 |
2019 Diciembre | 4 | 0 | 4 |
2019 Septiembre | 4 | 0 | 4 |
2019 Agosto | 2 | 0 | 2 |
2019 Junio | 3 | 0 | 3 |
2019 Abril | 1 | 3 | 4 |
2019 Marzo | 3 | 0 | 3 |
2019 Febrero | 1 | 0 | 1 |
2019 Enero | 3 | 0 | 3 |
2018 Diciembre | 3 | 0 | 3 |
2018 Noviembre | 7 | 0 | 7 |
2018 Octubre | 11 | 0 | 11 |
2018 Septiembre | 2 | 0 | 2 |
2018 Febrero | 61 | 3 | 64 |
2018 Enero | 93 | 18 | 111 |
2017 Diciembre | 98 | 15 | 113 |
2017 Noviembre | 67 | 11 | 78 |
2017 Octubre | 73 | 11 | 84 |
2017 Septiembre | 52 | 14 | 66 |
2017 Agosto | 50 | 7 | 57 |
2017 Julio | 57 | 10 | 67 |
2017 Junio | 48 | 22 | 70 |
2017 Mayo | 41 | 12 | 53 |
2017 Abril | 38 | 16 | 54 |
2017 Marzo | 30 | 21 | 51 |
2017 Febrero | 25 | 11 | 36 |
2017 Enero | 28 | 15 | 43 |
2016 Diciembre | 35 | 25 | 60 |
2016 Noviembre | 64 | 37 | 101 |
2016 Octubre | 8 | 9 | 17 |