Case and Research Letter
Atypical Ulcerated Lesions in a Patient With Cogan Syndrome
Lesiones ulcerativas atípicas en un paciente con síndrome de Cogan
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Solano-López, A. Montes-Torres, E. Tomero, J. Fraga, D. De Argila, E. Daudèc)n" "autores" => array:6 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Solano-López" "email" => array:1 [ 0 => "guitje1@hotmail.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" => "A." "apellidos" => "Montes-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Tomero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Fraga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "D." "apellidos" => "De Argila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "E." "apellidos" => "Daudèc)n" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Pathology, Hospital Universitario de la Princesa, Madrid, 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 ulcerativas atípicas en un paciente con síndrome de Cogan" ] ] "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" => 616 "Ancho" => 1600 "Tamanyo" => 270328 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Ulcerated epidermis with a diffuse inflammatory infiltrate in the dermis. (B) Infiltrates formed of neutrophils, histiocytes, lymphocytes, and occasional multinucleated giant cells.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cogan syndrome (CS) is a rare vasculitis characterized by recurrent interstitial keratitis and audiovestibular symptoms including hearing loss, tinnitus, and vertigo. To date, cutaneous lesions have been only rarely described associated with this autoimmune disease.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> We present the case of a patient with CS and multiple ulcerated lesions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 39-year-old white Spanish woman diagnosed with CS at age 31 years, with stromal keratitis and severe bilateral hearing loss, consulted for a 2-week history of ulcers that had started as pustules on the legs and then spread to the thighs, arms, abdomen, and back. At the time of onset, the patient was on treatment with methotrexate (25<span class="elsevierStyleHsp" style=""></span>mg/wk), prednisone (10<span class="elsevierStyleHsp" style=""></span>mg/d), and tozilizumab (8<span class="elsevierStyleHsp" style=""></span>mg/kg/mo). Physical examination revealed numerous pustules and ulcerated necrotic lesions on the legs, thighs, arms, back, and abdomen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). On suspicion of ecthyma, topical antibiotics and oral cloxacillin were prescribed. Smear cultures for bacteria, fungi, and mycobacteria were all negative. Additional tests were within normal limits and the chest radiograph was normal. Two weeks later the patient presented further pustules and enlargement of those previously present. At no time did she report fever or malaise. Histopathology of a biopsy from an ulcer on the left thigh revealed an ulcerated epidermis with epidermal necrosis and pustules at the border, with an abscessified area of skin and a diffuse dermal inflammatory infiltrate formed by neutrophils, histiocytes, lymphocytes, and occasional multinucleated giant cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). No clear signs of vasculitis were observed. Immunofluorescence was negative. Bacterial cultures from the cutaneous biopsy and new smears were positive for <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>/<span class="elsevierStyleItalic">Staphylococcus haemolyticus</span>, and <span class="elsevierStyleItalic">Streptococcus pyogenes</span>/<span class="elsevierStyleItalic">Pseudomonas putida fluorescens</span>, respectively. Oral cefuroxime and ciprofloxacin were started but the lesions showed no improvement. It was then that prednisone (at a dose of up to 1<span class="elsevierStyleHsp" style=""></span>mg/kg/d) was prescribed. The patient responded favorably, and in 2 weeks the lesions had completely re-epithelized except for an ulcer in the surgical wound of the biopsy and a linear ulcer on the left arm that had developed after trauma a week earlier, suggesting a pathergy phenomenon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). At follow-up, no lesions were observed. At the time of writing, the patient remains asymptomatic and continues her usual therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis of the cutaneous lesions in our patient was difficult, and ecthyma was our initial provisional diagnosis. The lack of response•and even a deterioration•of the lesions after antibiotic therapy, the pathergy phenomenon, and the favorable response to steroids led us consider a pyoderma gangrenosum (PG)-like neutrophilic dermatosis. However, the multiple lesions and the histopathology were not conclusive for either PG or other forms of neutrophilic dermatosis. Multiple lesions have rarely been described in PG.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In 70% of cases, PG is associated with an underlying disease such as inflammatory bowel disease (IBD), inflammatory arthritis, or a hematologic malignancy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3•5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Tirelli et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> found about 250 reports of patients with CS, only 13 of whom had concomitant chronic IBD; of these, none experienced improvement after therapy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of CS are unknown. Initially, the disease was thought to be caused by an infection, but it is now considered to be an autoimmune disorder.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In addition to the ocular and audiovestibular involvement, numerous systemic manifestations have been reported in CS, most commonly of cardiovascular, neurological, or gastrointestinal origin. Approximately 70% of patients have an underlying systemic disease. Vasculitis is considered to be the pathological mechanism<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>; however, even though swollen endothelial cells and focal fibrinoid deposits were seen in the biopsy from our patient, it was not possible to make a conclusive diagnosis of cutaneous vasculitis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In a review of the literature, we have found that CS has rarely been associated with skin manifestations, and in most cases such manifestations are reported as rash or ulcers, with no further detailed clinical description or histopathology study. In a multicenter study that included 32 patients with CS, only 7 showed skin and mucous membrane involvement or chondritis: 3 cases of rash, with evidence of vasculitis in only 2 of them, 1 patient with photosensitivity, 1 with vitiligo, 2 with oral ulcers and 2 with chondritis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Pagnini et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> described 23 children with CS; only 3 presented skin manifestations, all of which were described as rashes. As far as we are aware, these multiple ulcerated necrotic lesions have not previously been described in association with CS.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In summary, we have described an unusual case of multiple ulcerated necrotic lesions in a patient with CS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 1129 "Ancho" => 1600 "Tamanyo" => 165834 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Ulcerated necrotic lesions on both lower legs. (B) Linear ulcer on the left arm exhibiting the pathergy phenomenon.</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" => 616 "Ancho" => 1600 "Tamanyo" => 270328 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Ulcerated epidermis with a diffuse inflammatory infiltrate in the dermis. (B) Infiltrates formed of neutrophils, histiocytes, lymphocytes, and occasional multinucleated giant cells.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and outcome of Cogan syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Pagnini" 1 => "M.E. Zannin" 2 => "F. Vittadello" 3 => "M. Sari" 4 => "G. Simonini" 5 => "R. Cimaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2011.07.051" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2012" "volumen" => "160" "paginaInicial" => "303" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21920537" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyoderma gangrenosum: a review of clinical features and outcomes of 23 cases requiring inpatient management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.J. Ye" 1 => "J.M. Ye" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2014/461467" "Revista" => array:5 [ "tituloSerie" => "Dermatol Res Pract" "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "461467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25374597" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:1078155214541975" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyoderma gangrenosum due to lenalidomide use for multiple myeloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Dasanu" 1 => "B. Bockorny" 2 => "D.T. Alexandrescu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Oncol Pharm Pract" "fecha" => "2014" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The extraintestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Greenstein" 1 => "H.D. Janowitz" 2 => "D.B. Sachar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "1976" "volumen" => "55" "paginaInicial" => "401" "paginaFinal" => "412" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bullous pyoderma gangrenosum and leukemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.O. Perry" 1 => "R.K. Winkelmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1972" "volumen" => "106" "paginaInicial" => "901" "paginaFinal" => "905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4508849" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sudden hearing loss and Crohn disease: when Cogan syndrome must be suspected" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Tirelli" 1 => "P. Tomietto" 2 => "E. Quatela" 3 => "F. Perrino" 4 => "L. Nicastro" 5 => "L. Cattin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjoto.2015.02.013" "Revista" => array:6 [ "tituloSerie" => "Am J Otolaryngol" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "590" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25841536" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cogan's syndrome: an autoimmune inner ear disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Greco" 1 => "A. Gallo" 2 => "M. Fusconi" 3 => "G. Magliulo" 4 => "R. Turchetta" 5 => "C. Marinelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2012.07.012" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "396" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22846458" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cogan's syndrome: a systemic vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.D. Cheson" 1 => "A.Z. Bluming" 2 => "J. Alroy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "1976" "volumen" => "60" "paginaInicial" => "549" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1274989" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Typical and atypical Cogan's syndrome: 32 cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Grasland" 1 => "J. Pouchot" 2 => "E. Hachulla" 3 => "O. Blèc)try" 4 => "T. Papo" 5 => "P. Vinceneux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/keh228" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1007" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15150435" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000004/v1_201704280927/S1578219017301166/v1_201704280927/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/15782190/0000010800000004/v1_201704280927/S1578219017301166/v1_201704280927/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017301166?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 10 | 18 |
| 2024 Octubre | 82 | 44 | 126 |
| 2024 Septiembre | 73 | 28 | 101 |
| 2024 Agosto | 96 | 46 | 142 |
| 2024 Julio | 81 | 32 | 113 |
| 2024 Junio | 68 | 38 | 106 |
| 2024 Mayo | 53 | 34 | 87 |
| 2024 Abril | 79 | 29 | 108 |
| 2024 Marzo | 65 | 26 | 91 |
| 2024 Febrero | 65 | 34 | 99 |
| 2024 Enero | 52 | 36 | 88 |
| 2023 Diciembre | 54 | 19 | 73 |
| 2023 Noviembre | 71 | 29 | 100 |
| 2023 Octubre | 56 | 29 | 85 |
| 2023 Septiembre | 48 | 31 | 79 |
| 2023 Agosto | 48 | 17 | 65 |
| 2023 Julio | 52 | 31 | 83 |
| 2023 Junio | 40 | 27 | 67 |
| 2023 Mayo | 36 | 37 | 73 |
| 2023 Abril | 26 | 33 | 59 |
| 2023 Marzo | 51 | 23 | 74 |
| 2023 Febrero | 56 | 18 | 74 |
| 2023 Enero | 51 | 34 | 85 |
| 2022 Diciembre | 52 | 47 | 99 |
| 2022 Noviembre | 35 | 27 | 62 |
| 2022 Octubre | 48 | 27 | 75 |
| 2022 Septiembre | 66 | 34 | 100 |
| 2022 Agosto | 48 | 32 | 80 |
| 2022 Julio | 45 | 29 | 74 |
| 2022 Junio | 37 | 21 | 58 |
| 2022 Mayo | 28 | 28 | 56 |
| 2022 Abril | 31 | 35 | 66 |
| 2022 Marzo | 37 | 36 | 73 |
| 2022 Febrero | 39 | 35 | 74 |
| 2022 Enero | 52 | 34 | 86 |
| 2021 Diciembre | 42 | 42 | 84 |
| 2021 Noviembre | 41 | 38 | 79 |
| 2021 Octubre | 44 | 54 | 98 |
| 2021 Septiembre | 46 | 32 | 78 |
| 2021 Agosto | 32 | 36 | 68 |
| 2021 Julio | 23 | 25 | 48 |
| 2021 Junio | 25 | 28 | 53 |
| 2021 Mayo | 28 | 50 | 78 |
| 2021 Abril | 44 | 26 | 70 |
| 2021 Marzo | 59 | 16 | 75 |
| 2021 Febrero | 46 | 23 | 69 |
| 2021 Enero | 23 | 13 | 36 |
| 2020 Diciembre | 22 | 19 | 41 |
| 2020 Noviembre | 13 | 16 | 29 |
| 2020 Octubre | 23 | 28 | 51 |
| 2020 Septiembre | 20 | 20 | 40 |
| 2020 Agosto | 18 | 14 | 32 |
| 2020 Julio | 12 | 13 | 25 |
| 2020 Junio | 21 | 23 | 44 |
| 2020 Mayo | 13 | 12 | 25 |
| 2020 Abril | 14 | 8 | 22 |
| 2020 Marzo | 17 | 17 | 34 |
| 2020 Febrero | 8 | 0 | 8 |
| 2019 Septiembre | 1 | 0 | 1 |
| 2019 Agosto | 3 | 0 | 3 |
| 2019 Mayo | 0 | 1 | 1 |
| 2019 Abril | 0 | 3 | 3 |
| 2018 Diciembre | 5 | 0 | 5 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 9 | 0 | 9 |
| 2018 Septiembre | 9 | 0 | 9 |
| 2018 Febrero | 42 | 2 | 44 |
| 2018 Enero | 38 | 7 | 45 |
| 2017 Diciembre | 87 | 7 | 94 |
| 2017 Noviembre | 33 | 1 | 34 |
| 2017 Octubre | 34 | 5 | 39 |
| 2017 Septiembre | 37 | 8 | 45 |
| 2017 Agosto | 29 | 9 | 38 |
| 2017 Julio | 27 | 6 | 33 |
| 2017 Junio | 46 | 6 | 52 |
| 2017 Mayo | 59 | 27 | 86 |
| 2017 Abril | 8 | 3 | 11 |
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