Case for Diagnosis
Rapidly Progressive Infiltrated Plaques in a Transplant Recipient
Placas infiltradas de rápida evolución en paciente trasplantado
I. Salgüero Fernández
, F. Alfageme Roldán, D. Suarez Massa, G. Roustan Gullón
Autor para correspondencia
Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
Leído
4808
Vecesse ha leído el artículo
1846
Total PDF
2962
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219017300173" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.02.002" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "1443" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:255-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 797 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 636 "PDF" => 118 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731016301685" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.05.007" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "1443" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:255-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 241 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 153 "PDF" => 84 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASOS PARA EL DIAGNÓSTICO</span>" "titulo" => "Placas infiltradas de rápida evolución en paciente trasplantado" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "256" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Rapidly progressive infiltrated plaques in a transplant recipient" ] ] "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" => 1053 "Ancho" => 1583 "Tamanyo" => 308691 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Placas eritematosas infiltradas en región costal</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Salgüero Fernández, F. ALfageme Roldán, D. Suarez Massa, G. Roustan Gullón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Salgüero Fernández" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "ALfageme Roldán" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Suarez Massa" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Roustan Gullón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219017300173" "doi" => "10.1016/j.adengl.2017.02.002" "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/S1578219017300173?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016301685?idApp=UINPBA000044" "url" => "/00017310/0000010800000003/v1_201703250120/S0001731016301685/v1_201703250120/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219017300185" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.02.003" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "1564" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2017;108:257-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 727 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 560 "PDF" => 124 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Residents Forum</span>" "titulo" => "RF- Insufficient Exposure to Sunlight and Global Mortality: Should We Advise Against or Recommend Sun Exposure?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "258" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR- Exposición solar insuficiente y mortalidad global: ¿debemos recomendar o desaconsejar la exposición solar a nuestros pacientes?" ] ] "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" => 1737 "Ancho" => 3423 "Tamanyo" => 331294 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sistemic effects of UV radiation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.T. Monserrat-García, A. Ortíz-Prieto, P. Martín-Carrasco, J. Conejo-Mir-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.T." "apellidos" => "Monserrat-García" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ortíz-Prieto" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Martín-Carrasco" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016304306" "doi" => "10.1016/j.ad.2016.11.004" "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/S0001731016304306?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300185?idApp=UINPBA000044" "url" => "/15782190/0000010800000003/v1_201703250116/S1578219017300185/v1_201703250116/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219017300161" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.02.001" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "1426" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:253-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 575 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 405 "PDF" => 117 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Subcutaneous Tumor Deep to the Lateral Right Eyebrow" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "254" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración subcutánea en la cola de la ceja derecha" ] ] "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" => 480 "Ancho" => 600 "Tamanyo" => 150610 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P.P. García-Montero, A. Hernández-Nuñez, J.C. Tardío" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P.P." "apellidos" => "García-Montero" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Nuñez" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Tardío" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016301302" "doi" => "10.1016/j.ad.2015.10.022" "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/S0001731016301302?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300161?idApp=UINPBA000044" "url" => "/15782190/0000010800000003/v1_201703250116/S1578219017300161/v1_201703250116/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Rapidly Progressive Infiltrated Plaques in a Transplant Recipient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "256" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Salgüero Fernández, F. Alfageme Roldán, D. Suarez Massa, G. Roustan Gullón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Salgüero Fernández" "email" => array:1 [ 0 => "irenebsf@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme Roldán" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Suarez Massa" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Roustan Gullón" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Puerta de Hierro, Majadahonda, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas infiltradas de rápida evolución en paciente trasplantado" ] ] "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" => 975 "Ancho" => 1300 "Tamanyo" => 452634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10. B, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40.<span class="elsevierStyleHsp" style=""></span>C, Immunohistochemistry for CD31 and D2-40. D, Positive for human herpesvirus 8.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 54-year-old man who had received a lung transplant for treatment of emphysema. He was being treated with tacrolimus, mycophenolate mofetil, and prednisone. Rapidly progressive asymptomatic erythematous-violaceous plaques appeared on the patient's chest at 7 months posttransplant. The patient did not present fever or any other associated signs or symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">At the first visit, physical examination revealed isolated infiltrated erythematous plaques with a bilateral distribution in the pectoral region (adjacent to the thoracotomy site). One month later, the patient presented a large plaque that covered the lower and lateral parts of the chest and abdomen with 2 tumors, 1 of which was necrotic, on the surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy revealed a proliferation of spindle-shaped cells throughout the full thickness of the dermis that formed pseudovascular clefts and fascicles. The cells showed moderate atypia and occasional mitotic figures. Immunohistochemistry was positive for CD31, D2-40, and human herpesvirus 8 (HHV8) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Iatrogenic Kaposi sarcoma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0030" class="elsevierStylePara elsevierViewall">At the time of the transplant, serology for HHV8 was positive in the donor and negative in the recipient. The patient presented seroconversion for HHV8. Subsequently, HHV8 was detected by polymerase chain reaction (PCR) in the serum of the patient, with high levels of viremia (><span class="elsevierStyleHsp" style=""></span>1000<span class="elsevierStyleHsp" style=""></span>copies/mL).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Computed tomography and magnetic resonance imaging studies were carried out and no evidence of visceral involvement was detected.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment was initiated with doxorubicin, mycophenolate was withdrawn, the dose of tacrolimus was decreased, and everolimus was introduced. With this treatment regimen, new lesions stopped appearing and the existing lesions flattened.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Kaposi sarcoma is a tumor derived from endothelial cells. It presents a variable clinical course, ranging from minimal involvement to systemic progression that affects internal organs. There are 4 types of Kaposi sarcoma: classical, endemic, iatrogenic, and human immunodeficiency virus (HIV)–associated.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Kaposi sarcoma develops in 0.1%-5% of solid organ transplant recipients, especially kidney recipients, who generally receive combined immunosuppressive therapy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Immunity and viral infection play a role in the etiology and pathogenesis of Kaposi sarcoma and interact with HHV8, which is a necessary but not sufficient condition for the development of the disease.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Most cases in transplant patients are caused by the reactivation of a previous infection, while a few are caused by a primary infection related to the transplanted organ.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Approximately 30% of seronegative recipients seroconvert after receiving an organ from a HHV8-seropositive donor. Lebbe et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> monitored 454 HHV8 seronegative transplant recipients for 2 years and observed a seroconversion rate of 29%-31%. Notably, the prevalence of HHV8-positive viremia in these patients was very low, <<span class="elsevierStyleHsp" style=""></span>1% (4 of 454 patients), possibly due to an adaptive immune response against HHV8 demonstrated by Lambert et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Of the 4 patients with HHV8-positive viremia, 2 had high levels of viremia (><span class="elsevierStyleHsp" style=""></span>1000<span class="elsevierStyleHsp" style=""></span>copies/mL) and developed Kaposi sarcoma.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The authors concluded that HHV8 transmission is common and that morbidity caused by the virus is rare but can be severe. Therefore, they recommend screening donors for HHV8 in cases in which the recipient is seronegative.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study did not include any patients who, like our patient, had received a lung transplant (possibly because kidney transplant is the most common solid organ transplant) and although we have not found any cases of Kaposi sarcoma in lung transplant recipients in the reviewed literature, it can be assumed that the situation is similar given that these patients also receive combined immunosuppressive therapy.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => 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: Salgüero Fernández I, Alfageme Roldán F, Suarez Massa D, Roustan Gullón G. Placas infiltradas de rápida evolución en paciente trasplantado. Actas Dermosifiliogr. 2017;108:255–256.</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" => 1053 "Ancho" => 1583 "Tamanyo" => 316225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infiltrated erythematous plaques in the costal region.</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" => 975 "Ancho" => 1300 "Tamanyo" => 452634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10. B, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40.<span class="elsevierStyleHsp" style=""></span>C, Immunohistochemistry for CD31 and D2-40. D, Positive for human herpesvirus 8.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Placa preesternal de larga evolución" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Blasco-Morente" 1 => "C. Garrido-Colmenero" 2 => "I. Pérez-López" 3 => "J. Espelt-Otero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2015.02.006" "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2015" "volumen" => "106" "paginaInicial" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25917959" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on Kaposi's sarcoma and other HHV8 associated diseases, parts <span class="elsevierStyleSmallCaps">i</span> and <span class="elsevierStyleSmallCaps">ii</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "U.R. Hengge" 1 => "T. Ruzicka" 2 => "S.K. Tyring" 3 => "M. Stuschke" 4 => "M. Roggendorf" 5 => "R.A. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2002" "paginaInicial" => "281" "paginaFinal" => "292" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of cancers in human immunodeficiency virus infection and after organ transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.E. Grulich" 1 => "C.M. Vajdic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.seminoncol.2014.12.029" "Revista" => array:6 [ "tituloSerie" => "Semin Oncol." "fecha" => "2015" "volumen" => "42" "paginaInicial" => "247" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25843729" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human herpesvirus 8 (HHV8) transmission and related morbidity in organ recipients" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Skin and Organ Transplantation Group of the French Society of Dermatology" "etal" => true "autores" => array:6 [ 0 => "C1 Lebbe" 1 => "R. Porcher" 2 => "A.G. Marcelin" 3 => "F. Agbalika" 4 => "E. Dussaix" 5 => "D. Samuel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2012.04290.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "207" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23057808" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences in the frequency and function of HHV8-specific CD8 T cells between asymptomatic HHV 8 infection in Kaposi sarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Lambert" 1 => "M. Gannagé" 2 => "A. Karras" 3 => "M. Abel" 4 => "C. Legendre" 5 => "D. Kerob" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2006-03-014225" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2006" "volumen" => "108" "paginaInicial" => "3871" "paginaFinal" => "3880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16926293" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000003/v1_201703250116/S1578219017300173/v1_201703250116/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000003/v1_201703250116/S1578219017300173/v1_201703250116/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017300173?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 6 | 16 |
| 2024 Octubre | 55 | 36 | 91 |
| 2024 Septiembre | 76 | 26 | 102 |
| 2024 Agosto | 98 | 48 | 146 |
| 2024 Julio | 70 | 28 | 98 |
| 2024 Junio | 60 | 31 | 91 |
| 2024 Mayo | 72 | 37 | 109 |
| 2024 Abril | 70 | 33 | 103 |
| 2024 Marzo | 57 | 37 | 94 |
| 2024 Febrero | 61 | 36 | 97 |
| 2024 Enero | 50 | 29 | 79 |
| 2023 Diciembre | 52 | 14 | 66 |
| 2023 Noviembre | 67 | 24 | 91 |
| 2023 Octubre | 59 | 17 | 76 |
| 2023 Septiembre | 78 | 33 | 111 |
| 2023 Agosto | 42 | 11 | 53 |
| 2023 Julio | 49 | 33 | 82 |
| 2023 Junio | 47 | 24 | 71 |
| 2023 Mayo | 43 | 31 | 74 |
| 2023 Abril | 49 | 16 | 65 |
| 2023 Marzo | 68 | 25 | 93 |
| 2023 Febrero | 49 | 28 | 77 |
| 2023 Enero | 24 | 31 | 55 |
| 2022 Diciembre | 42 | 47 | 89 |
| 2022 Noviembre | 28 | 24 | 52 |
| 2022 Octubre | 18 | 24 | 42 |
| 2022 Septiembre | 13 | 26 | 39 |
| 2022 Agosto | 26 | 31 | 57 |
| 2022 Julio | 21 | 37 | 58 |
| 2022 Junio | 17 | 20 | 37 |
| 2022 Mayo | 25 | 38 | 63 |
| 2022 Abril | 32 | 28 | 60 |
| 2022 Marzo | 38 | 48 | 86 |
| 2022 Febrero | 24 | 24 | 48 |
| 2022 Enero | 28 | 41 | 69 |
| 2021 Diciembre | 22 | 40 | 62 |
| 2021 Noviembre | 31 | 50 | 81 |
| 2021 Octubre | 38 | 57 | 95 |
| 2021 Septiembre | 23 | 38 | 61 |
| 2021 Agosto | 31 | 42 | 73 |
| 2021 Julio | 21 | 32 | 53 |
| 2021 Junio | 22 | 36 | 58 |
| 2021 Mayo | 45 | 42 | 87 |
| 2021 Abril | 60 | 73 | 133 |
| 2021 Marzo | 52 | 32 | 84 |
| 2021 Febrero | 34 | 33 | 67 |
| 2021 Enero | 20 | 30 | 50 |
| 2020 Diciembre | 39 | 20 | 59 |
| 2020 Noviembre | 19 | 21 | 40 |
| 2020 Octubre | 27 | 25 | 52 |
| 2020 Septiembre | 43 | 15 | 58 |
| 2020 Agosto | 22 | 31 | 53 |
| 2020 Julio | 28 | 22 | 50 |
| 2020 Junio | 36 | 28 | 64 |
| 2020 Mayo | 25 | 14 | 39 |
| 2020 Abril | 42 | 12 | 54 |
| 2020 Marzo | 23 | 13 | 36 |
| 2020 Febrero | 8 | 0 | 8 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 7 | 2 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 9 | 0 | 9 |
| 2019 Agosto | 5 | 0 | 5 |
| 2019 Julio | 6 | 0 | 6 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 7 | 1 | 8 |
| 2019 Abril | 18 | 3 | 21 |
| 2019 Marzo | 5 | 0 | 5 |
| 2019 Febrero | 6 | 0 | 6 |
| 2019 Enero | 6 | 0 | 6 |
| 2018 Diciembre | 16 | 0 | 16 |
| 2018 Noviembre | 17 | 0 | 17 |
| 2018 Octubre | 30 | 0 | 30 |
| 2018 Septiembre | 43 | 0 | 43 |
| 2018 Febrero | 19 | 4 | 23 |
| 2018 Enero | 21 | 5 | 26 |
| 2017 Diciembre | 32 | 6 | 38 |
| 2017 Noviembre | 19 | 5 | 24 |
| 2017 Octubre | 22 | 5 | 27 |
| 2017 Septiembre | 25 | 9 | 34 |
| 2017 Agosto | 23 | 9 | 32 |
| 2017 Julio | 16 | 7 | 23 |
| 2017 Junio | 38 | 6 | 44 |
| 2017 Mayo | 33 | 8 | 41 |
| 2017 Abril | 177 | 25 | 202 |
| 2017 Marzo | 19 | 23 | 42 |
Mostrar todo
