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Acute Generalized Exanthematous Pustulosis Simulating Toxic Epidermal Necrolysis: Overlapping Processes
Pustulosis exantemática generalizada aguda simulando necrólisis epidérmica tóxica: forma combinada
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C) Pústula subcórnea con abundantes neutrófilos (hematoxilina-eosina x200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. García Abellán, J. Matarredona Catalá, A. Jaen Larrieu, I. Valencia Ramírez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "García Abellán" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Matarredona Catalá" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Jaen Larrieu" ] 3 => array:2 [ "nombre" => "I." 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"apellidos" => "Vestita" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300796" "doi" => "10.1016/j.ad.2018.02.004" "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/S0001731018300796?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301161?idApp=UINPBA000044" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301161/v1_201806040407/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018301318" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.04.012" "estado" => "S300" "fechaPublicacion" => "2018-06-01" "aid" => "1815" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:457-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 46 "HTML" => 46 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Human Papilloma Virus and the Risk of Squamous Cell Carcinoma Arising in Hidradenitis Suppurativa" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "457" "paginaFinal" => "459" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Virus del papiloma humano y riesgo de desarrollo de carcinoma escamocelular en la hidradenitis supurativa" ] ] "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" => 1400 "Ancho" => 1867 "Tamanyo" => 774607 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Well-differentiated squamous cell carcinoma covering the fistulous tract. 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"apellidos" => "Repiso Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305495" "doi" => "10.1016/j.ad.2017.06.019" "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/S0001731017305495?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301318?idApp=UINPBA000044" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301318/v1_201806040407/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute Generalized Exanthematous Pustulosis Simulating Toxic Epidermal Necrolysis: Overlapping Processes" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "460" "paginaFinal" => "462" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. García Abellán, J. Matarredona Catalá, A. Jaen Larrieu, I. Valencia Ramírez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "García Abellán" "email" => array:1 [ 0 => "javiergarciaabellan@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" => "J." "apellidos" => "Matarredona Catalá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Jaen Larrieu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Valencia Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Elche, Elche, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario de Elche, Elche, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pustulosis exantemática generalizada aguda simulando necrólisis epidérmica tóxica: forma combinada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1A and 1B" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2117 "Ancho" => 2000 "Tamanyo" => 484727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous areas on the back with positive Nikolski sign (arrow). C, Subcorneal pustule with abundant neutrophils (hematoxylin-eosin x200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the report by Horcajada-Reales et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> of 2 cases with overlapping clinical characteristics involving acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN). We would like to share a similar case we encountered in our practice.</p><p id="par0010" class="elsevierStylePara elsevierViewall">AGEP and TEN are well-established, distinct entities belonging to the group of severe cutaneous drug reactions. They both have characteristic clinical presentations and differ in pathogenesis, prognosis, and treatment. It is, however, sometimes hard to distinguish between the 2 conditions and this difficulty can lead to an erroneous clinical diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">AGEP is a skin condition generally associated with a good prognosis. It typically presents as a rapidly evolving pustular eruption accompanied by fever and leukocytosis with neutrophilia. A skin biopsy reveals a subcorneal pustule.</p><p id="par0020" class="elsevierStylePara elsevierViewall">TEN, on the other hand, often affects the mucous membranes and is accompanied by fever and generalized discomfort, which precedes the appearance of eythematous-violaceous exanthema and epidermal detachment<span class="elsevierStyleItalic">.</span> Histological findings include epidermal necrosis and apoptotic keratinocytes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our patient was an 82-year-old woman with no known allergies. She was admitted to hospital because of a 39<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> fever and a violaceous exanthema mainly affecting the trunk. The eruption was characterized by skin detachment in some areas and a positive Nikolski sign (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1A and 1B</a>). Laboratory testing revealed elevated transaminase levels: gamma glutamyl-transferase (GGT), 494 U/L; fatty acid (FA), 364 U/L; glutamic-oxalacetic transaminase (GOT), 91 U/L; and glutamic-pyruvic transaminase (GPT), 99 U/L.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Two weeks before admission she had been diagnosed with acute self-limited gastroenteritis and treated with trimethoprim sulfamethoxazole. The only personal medical history of interest was dyslipidemia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Piperacillin-tazobactam was prescribed for a suspected biliary tract infection and cholangio-magnetic resonance imaging revealed a small extrahepatic bile duct ectasia. The results of blood cultures were negative. <span class="elsevierStyleItalic">Enterococcus faecalis</span> was isolated in a urine culture. Serology was negative for hepatitis A, B and C and HIV.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the suspected diagnosis of TEN secondary to sulfamethoxazole or cotrimoxazole, corticosteroids (prednisone 60<span class="elsevierStyleHsp" style=""></span>mg/d for 5 days) and intravenous immunoglobulins (1<span class="elsevierStyleHsp" style=""></span>g/kg/d for 2 days) were prescribed and achieved an excellent clinical response (complete resolution of the condition within 8 days).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Histological study revealed subcorneal pustules with abundant neutrophils, both findings consistent with a diagnosis of generalized exanthematous pustulosis (Fig 1C).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The possibility of different severe adverse drug reactions overlapping is a subject of some debate. Although they are distinct entities, the clinical features can be similar and have certain pathophysiologic mechanisms in common.</p><p id="par0055" class="elsevierStylePara elsevierViewall">AGEP, for instance, can present with vesicular-bullous lesions that mimic the clinical appearance of TEN.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> There are also forms of TEN that manifest as pustules or blisters.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Cases have been reported of patients who, after initially presenting with AGEP, subsequently developed TEN.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> In other cases, such as the one described here, the patient presents the clinical features of TEN with histological findings consistent with AGEP.</p><p id="par0065" class="elsevierStylePara elsevierViewall">There are 17 published cases of overlapping forms, most of which are associated with antibiotic use.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The main differences between AGEP and TEN are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">In terms of pathogenesis, it seems clear that both conditions are type 4 hypersensitivity reactions (HSR) and that the difference between them lies in the type of T-cell activated in each case.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In both cases, the initial stage is characterized by keratinocyte cytolysis caused by CD8+ T cells. Subsequently, the two conditions diverge and the pathway differs in each one. In AGEP, activated CD4+ T cells produce interleukin (IL) 8, IL-17 and IL-36, which recruit neutrophils and lead to the formation of pustules (type 4d HSR).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In TEN, by contrast, CD8+ T cells release perforin and granzyme B, triggering massive keratinocyte apoptosis by activating the Fas-Fas-ligand receptor and tumor necrosis factor alpha (TNF-α) (type 4c HSR). The latest research is focused on the investigation of certain drug-specific human leukocyte antigens (HLA) that predispose individuals to a genetic susceptibility for TEN when an individual with a specific HLA allele is exposed to a specific drug.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Overlapping forms are probably caused by a combined hypersensitivity reaction between such alleles and a specific drug.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In most cases, the eventual course of the disease will be AGEP. However, in some patients it has led to extensive skin lesions, multiorgan involvement, and even death.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">It is important to recognize these cases because, given their greater severity, they should be managed and treated as TEN.</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: García Abellán J, Matarredona Catalá J, Jaen Larrieu A, Valencia Ramírez I. Pustulosis exantemática generalizada aguda simulando necrólisis epidérmica tóxica: forma combinada. Actas Dermosifiliogr. 2018;109:460–462.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1A and 1B" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2117 "Ancho" => 2000 "Tamanyo" => 484727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous areas on the back with positive Nikolski sign (arrow). C, Subcorneal pustule with abundant neutrophils (hematoxylin-eosin x200).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AGEP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TEN \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexural \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Generalized \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pustules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nikolsky<span class="elsevierStyleSup">+</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Frequent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mucosal involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+ oral mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">++++ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Occasionally \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Frequent high fever \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood test results \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neutrophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neutropenia and elevated transaminases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Latency period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hours or days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-3 wks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Histopathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcorneal pustules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epidermal necrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Withdrawal of the drug \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drug withdrawal and Intravenous immunoglobulins \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recovery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3-6 wks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1761149.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Main Differences Between Acute Generalized Exanthematous Pustulosis (AGEP) and Toxic Epidermal Necrolysis (TEN).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toxicodermias graves: ¿existen las formas combinadas?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Horcajada-Reales" 1 => "A. Pulido-Pérez" 2 => "R. Suárez-Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2015.08.006" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2016" "volumen" => "107" "paginaInicial" => "23" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26520037" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pustulosis exantemática aguda generalizada con mucositis y dermatitis exfoliativa generalizada simulando una necrólisis epidérmica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Torregrosa-Calatayud" 1 => "M. Victoria-Martínez a" 2 => "J. García-Cadavia" 3 => "V. Alegre de Miguel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "198" "paginaFinal" => "200" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute generalized exanthematous pustulosis simulating toxic epidermal necrolysis: A case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Peermohamed" 1 => "R.M. Haber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2011.147" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2011" "volumen" => "147" "paginaInicial" => "697" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21690532" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe flucloxacillin-induced acute generalized exanthematous pustulosis (AGEP), with toxic epidermal necrolysis (TEN)-like features: Does overlap between AGEP and TEN exist. Clinical report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Van Hattem" 1 => "G.I. Beerthuizen" 2 => "S.H. Kardaun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.13152" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2014" "volumen" => "171" "paginaInicial" => "1539" "paginaFinal" => "1545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24888401" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse cutaneous drug eruptions: Current understanding" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Hoetzenecker" 1 => "M. Nägeli" 2 => "E.T. Mehra" 3 => "A.N. Jensen" 4 => "I. Saulite" 5 => "P. Schmid-Grendelmeier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00281-015-0540-2" "Revista" => array:6 [ "tituloSerie" => "Semin Immunopathol" "fecha" => "2016" "volumen" => "38" "paginaInicial" => "75" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26553194" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rapidly progressive and fatal case of atypical acute generalized exanthematous pustulosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Krishna" 1 => "N. Malakouti" 2 => "A.G. Ortega-Loayza" 3 => "N.K. Brinster" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.03.007" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "e89" "paginaFinal" => "e90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25128141" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301380/v1_201806040407/en/main.assets" "Apartado" => array:4 [ "identificador" => "6208" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000005/v1_201806040407/S1578219018301380/v1_201806040407/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301380?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
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