Case and Research Letters
Erythema Annulare Centrifugum in a Patient With Budd-Chiari Syndrome
Eritema anular centrífugo en un paciente con síndrome de Budd-Chiari
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El análisis histopatológico realizado (tinción hematoxilina-eosina) reveló una epidermis sin cambios significativos y un infiltrado histiolinfocítico perivascular tanto en la dermis superficial como en la dermis profunda. No se observó evidencia alguna de vasculitis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.S. Borges, A. Brasileiro, S. Santos, J. Saiote" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.S." "apellidos" => "Borges" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Brasileiro" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Santos" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Saiote" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018302312" "doi" => "10.1016/j.adengl.2018.06.019" "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/S1578219018302312?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018300334?idApp=UINPBA000044" "url" => "/00017310/0000010900000008/v1_201810020614/S0001731018300334/v1_201810020614/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S157821901830235X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.07.001" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1894" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:757-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Successful Suppression of Recurrent Zosteriform Mycosis Fungoides With Maintenance Valacyclovir" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "757" "paginaFinal" => "760" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Supresión de un cuadro de micosis fungoide recurrente con distribución zosteriforme mediante tratamiento de mantenimiento con valaciclovir" ] ] "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" => 2107 "Ancho" => 1867 "Tamanyo" => 990870 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infiltrado linfoide dérmico atípico para las células CD4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>y CD8<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>con epidermotropismo focal; los estudios inmunohistoquímicos realizados confirmaron presencia de células T CD3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>en dermis y epidermis con predominancia de células CD4 sobre células CD8 en la dermis, en una proporción CD4:CD8 de, aproximadamente, 4:1. En la epidermis, se observó un subgrupo de linfocitos atípicos negativos para CD4 y CD8. Hay pérdida de expresión de CD7. Pocas células fueron reactivas al marcador CD30. La mayoría de los linfocitos dieron positivo para el receptor de la cadena beta de linfocitos T (BF1) y negativo para el receptor de la cadena gamma de linfocitos T. A) Tinción hematoxilina y eosina, 40x. B) Tinción hematoxilina y eosina, 200x C-F) inmunohistoquímica, 200x.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.J. Lewis, T. Hinojosa, W.H. Chan, J.H. Wu, M. Duvic" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D.J." "apellidos" => "Lewis" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Hinojosa" ] 2 => array:2 [ "nombre" => "W.H." "apellidos" => "Chan" ] 3 => array:2 [ "nombre" => "J.H." "apellidos" => "Wu" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Duvic" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101830036X" "doi" => "10.1016/j.ad.2017.09.023" "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/S000173101830036X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901830235X?idApp=UINPBA000044" "url" => "/15782190/0000010900000008/v1_201810020631/S157821901830235X/v1_201810020631/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157821901830266X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.07.013" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1909" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:752-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Complete Spontaneous Regression of the Primary Tumor in Merkel Cell Carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "752" "paginaFinal" => "754" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Regresión completa espontánea del tumor primario en el carcinoma de células de Merkel" ] ] "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" => 962 "Ancho" => 1512 "Tamanyo" => 326867 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 1. A, Clinical image of Merkel cell carcinoma on the scalp. B, Appearance of scalp after regression of the lesions. C, Histologic image of initial biopsy of the scalp tumor showing a dense dermal proliferation of basophilic cells (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×40). D, Histologic image of biopsy of scalp tumor after regression, showing only residual fibrosis and a mild chronic inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Marcoval, F. Valentí-Medina, R.M. Penín, J. Bermejo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Marcoval" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Valentí-Medina" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Penín" ] 3 => array:2 [ "nombre" => "J." 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Borges, A. Brasileiro, S. Santos, J. Saiote" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A.S." "apellidos" => "Borges" "email" => array:1 [ 0 => "a.sofia.r.borges@gmail.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" => "Brasileiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Saiote" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología y Venereología, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gastroenterología, Hospital Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eritema anular centrífugo en un paciente con síndrome de Budd-Chiari" ] ] "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" => 2026 "Ancho" => 2143 "Tamanyo" => 809732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a, x40; b, x100; c, x200) Histopathological examination (H&E) revealed an epidermis without significant changes and a perivascular histolymphocytic infiltrate in the superficial and deep dermis. There is no evidence of vasculitis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old woman was observed for non-pruritic erythematous annular plaques, located symmetrically on knees, which have started 3 months before and had been progressing with peripheral extension and central clearing (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Past medical history was unremarkable until 1 week before, when she presented with abdominal pain, nausea, hepatomegaly, ascites, decreased urinary output and asthenia. Family history was irrelevant and the patient denied taking any medication.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Histopathologic examination of skin lesions biopsy showed a perivascular lymphocytic infiltrate in the superficial and deep dermis, suggestive of erythema annulare centrifugum (EAC), based on the correlation between clinical and histological findings (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) on hematoxylin and eosin stain. Periodic acid-Schiff and Pearls colorations did not show remarkable findings.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory tests detected thrombocytosis; negative viral hepatitis serology, negative HIV, CMV and EBV serology; negative alfa fetoprotein; negative autoantibodies (ANA, anti-sDNA, antiphopholipid); undetected rheumatoid factor; normal levels of protein C, S, antithrombin II and homocysteine, no resistance to activate protein C. The search for prothrombin G20210A mutation was negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Doppler ultrasonography and computed tomography examination revealed thrombosis of the sus-hepatic veins and portal hypertension with the diagnostic of Budd Chiari-Syndrome (BCS). Further investigation led to the diagnosis of essential thrombocythemia (ET) JAK2 negative, confirmed by bone marrow examination.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite anticoagulation and optimized diuretic therapy, renal function worsened and ascites persisted, and the patient was proposed for liver transplantation. Few weeks after transplantation, spontaneous resolution of cutaneous lesions was noticed, without relapse during 2 years of follow-up. Concerning her hematologic disease, she has been treated with hydroxyurea, however with poor results.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Erythema annulare centrifugum (EAC) is a rare inflammatory skin disease presenting with erythematous papules or plaques that expand centrifugally with central clearing resulting in an annular shape.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a> There are two types, superficial and deep, but this classification is not completely accepted and according to some authors the designation EAC should be reserved for the superficial type only.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">EAC has been considered a hypersensitivity reaction, rather than a specific clinicopathologic entity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> When a trigger is identified, the treatment of the underlying condition mostly results in spontaneous resolution of the skin lesions.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> EAC has been associated with many different entities, including infections, malignant neoplasms,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> various autoimmune diseases<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3,7</span></a> and drugs,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> but its association with BCS or liver failure had not been previously described.</p><p id="par0040" class="elsevierStylePara elsevierViewall">BCS is a rare vascular liver disease resulting from the obstruction of the hepatic venous outflow tract that can result in liver failure.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The most common underlying prothrombotic risk factor is a myeloproliferative disorder as ET, although it is now recognized that almost half of patients have multiple underlying prothrombotic risk factors.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Some chemical mediators released from activated platelets could explain some cutaneous findings associated with thrombocytosis such as erythromelalgia, acute febril neutrophilic dermatosis and arterial thrombotic diseases<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> but not EAC.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our case, the skin lesion resolved without recurrence after liver transplantation. On the other hand, there was not an haematological improvement despite preconized therapy making the association between EAC and BCS/liver disease more likely than with ET.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To the best of our knowledge, we report the first case of EAC probably associated with BCS in a patient with ET. Our report shows a new association of EAC with a systemic disease, thus emphasizing the importance of clinical and complementary evaluation in a patient with EAC, as well as the importance of more studies to clarify the physiopathology of this clinical identity.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Borges AS, Brasileiro A, Santos S, Saiote J. Eritema anular centrífugo en un paciente con síndrome de Budd-Chiari. Actas Dermosifiliogr. 2018;109:755–757.</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" => 1015 "Ancho" => 1733 "Tamanyo" => 162163 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a,b) Physical examination revealed well-defined erythematous annular plaques, located symmetrically on knees arranged in an annulare shape.</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" => 2026 "Ancho" => 2143 "Tamanyo" => 809732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a, x40; b, x100; c, x200) Histopathological examination (H&E) revealed an epidermis without significant changes and a perivascular histolymphocytic infiltrate in the superficial and deep dermis. There is no evidence of vasculitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fitzpatrick's dermatology in general medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.A. Goldsmith" 1 => "S.I. Katz" 2 => "B.A. Gilchrest" 3 => "A.S. Paller" 4 => "D.J. Leffell" 5 => "K. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 5 | 12 |
| 2024 Octubre | 75 | 59 | 134 |
| 2024 Septiembre | 89 | 38 | 127 |
| 2024 Agosto | 89 | 67 | 156 |
| 2024 Julio | 79 | 44 | 123 |
| 2024 Junio | 85 | 49 | 134 |
| 2024 Mayo | 74 | 47 | 121 |
| 2024 Abril | 78 | 36 | 114 |
| 2024 Marzo | 77 | 31 | 108 |
| 2024 Febrero | 70 | 45 | 115 |
| 2024 Enero | 65 | 49 | 114 |
| 2023 Diciembre | 74 | 19 | 93 |
| 2023 Noviembre | 99 | 24 | 123 |
| 2023 Octubre | 97 | 23 | 120 |
| 2023 Septiembre | 98 | 47 | 145 |
| 2023 Agosto | 56 | 27 | 83 |
| 2023 Julio | 74 | 46 | 120 |
| 2023 Junio | 55 | 28 | 83 |
| 2023 Mayo | 66 | 30 | 96 |
| 2023 Abril | 59 | 27 | 86 |
| 2023 Marzo | 55 | 36 | 91 |
| 2023 Febrero | 58 | 28 | 86 |
| 2023 Enero | 36 | 32 | 68 |
| 2022 Diciembre | 65 | 32 | 97 |
| 2022 Noviembre | 47 | 25 | 72 |
| 2022 Octubre | 30 | 38 | 68 |
| 2022 Septiembre | 27 | 32 | 59 |
| 2022 Agosto | 38 | 49 | 87 |
| 2022 Julio | 38 | 55 | 93 |
| 2022 Junio | 36 | 34 | 70 |
| 2022 Mayo | 41 | 39 | 80 |
| 2022 Abril | 63 | 34 | 97 |
| 2022 Marzo | 67 | 44 | 111 |
| 2022 Febrero | 59 | 24 | 83 |
| 2022 Enero | 80 | 35 | 115 |
| 2021 Diciembre | 58 | 31 | 89 |
| 2021 Noviembre | 70 | 43 | 113 |
| 2021 Octubre | 55 | 40 | 95 |
| 2021 Septiembre | 62 | 36 | 98 |
| 2021 Agosto | 66 | 33 | 99 |
| 2021 Julio | 67 | 29 | 96 |
| 2021 Junio | 111 | 30 | 141 |
| 2021 Mayo | 40 | 44 | 84 |
| 2021 Abril | 117 | 71 | 188 |
| 2021 Marzo | 59 | 38 | 97 |
| 2021 Febrero | 83 | 35 | 118 |
| 2021 Enero | 40 | 14 | 54 |
| 2020 Diciembre | 34 | 23 | 57 |
| 2020 Noviembre | 24 | 24 | 48 |
| 2020 Octubre | 12 | 12 | 24 |
| 2020 Septiembre | 25 | 19 | 44 |
| 2020 Agosto | 16 | 17 | 33 |
| 2020 Julio | 16 | 15 | 31 |
| 2020 Junio | 19 | 26 | 45 |
| 2020 Mayo | 15 | 21 | 36 |
| 2020 Abril | 17 | 12 | 29 |
| 2020 Marzo | 11 | 10 | 21 |
| 2020 Febrero | 1 | 0 | 1 |
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