Case for Diagnosis
Ulceration on the Abdomen
Úlceras en abdomen
M.I. Martínez-González
, S. Goula-Fernández, R. González-Pérez
Autor para correspondencia
Servicio de Dermatología y Venereología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
Leído
3646
Vecesse ha leído el artículo
1596
Total PDF
2050
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219019300940" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.03.002" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2064" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:311-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "HTML" => 4 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018304307" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.11.023" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2064" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:311-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 339 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 268 "PDF" => 70 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Úlceras en abdomen" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ulceration on the Abdomen" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 745 "Ancho" => 1500 "Tamanyo" => 231538 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Hematoxilina-eosina ×2.1. B) Hematoxilina-eosina ×65.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.I. Martínez-González, S. Goula-Fernández, R. González-Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.I." "apellidos" => "Martínez-González" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Goula-Fernández" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "González-Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019300940" "doi" => "10.1016/j.adengl.2019.03.002" "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/S1578219019300940?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304307?idApp=UINPBA000044" "url" => "/00017310/0000011000000004/v2_201905040606/S0001731018304307/v2_201905040606/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019301076" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.12.026" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1937" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2019;110:313-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3 "HTML" => 3 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "FR- Risk of Nonmelanoma Skin Cancer in Patients on Hemodialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR- Riesgo de cáncer cutáneo no melanoma en pacientes hemodializados" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Aguayo Carreras, J. Tercedor Sánchez, R. Ruiz Villaverde" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P. Aguayo" "apellidos" => "Carreras" ] 1 => array:2 [ "nombre" => "J. Tercedor" "apellidos" => "Sánchez" ] 2 => array:2 [ "nombre" => "R. Ruiz" "apellidos" => "Villaverde" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018301261" "doi" => "10.1016/j.ad.2017.12.009" "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/S0001731018301261?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301076?idApp=UINPBA000044" "url" => "/15782190/0000011000000004/v1_201905070820/S1578219019301076/v1_201905070820/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S157821901930109X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.03.015" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "2068" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:309-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8 "HTML" => 8 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Papular Eruption on Sun-Exposed Skin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "310" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erupción papulosa fotodistribuida" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1191 "Ancho" => 1667 "Tamanyo" => 468440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin ×4. B and C), Hematoxylin–eosin ×10.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Schneller-Pavelescu, E. Vergara-de Caso, M.M. Blanes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Schneller-Pavelescu" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Vergara-de Caso" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Blanes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018304344" "doi" => "10.1016/j.ad.2017.11.024" "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/S0001731018304344?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930109X?idApp=UINPBA000044" "url" => "/15782190/0000011000000004/v1_201905070820/S157821901930109X/v1_201905070820/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Ulceration on the Abdomen" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.I. Martínez-González, S. Goula-Fernández, R. González-Pérez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.I." "apellidos" => "Martínez-González" "email" => array:1 [ 0 => "mariaisabel.martinezgonzalez@osakidetza.eus" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Goula-Fernández" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "González-Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología y Venereología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlceras en abdomen" ] ] "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" => 745 "Ancho" => 1500 "Tamanyo" => 229738 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.1. B, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>65.</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 46-year-old woman with rheumatoid arthritis, for which she was in her third year of treatment with oral corticosteroids (deflazacort, 6 mg/d) and methotrexate (10 mg/wk). She was seen for ulcerative lesions in the right abdominal fold that had appeared 7 days earlier.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an ulcer of 50<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm with a fibrinous base, a violaceous border, and small adjacent ulcerations (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had been initially treated for 20 days with betamethasone-gentamicin (Diprogenta), which caused worsening of the larger lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histology of a skin biopsy revealed an absent epidermis, which had been replaced with granulation tissue, and the presence in endothelial cells of focally distributed, basophilic, intranuclear viral inclusions surrounded by a clear halo (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The diagnosis was confirmed by polymerase chain reaction (PCR) analysis of the tissue.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Skin ulcers due to cytomegalovirus (CMV).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The lesion evolved favorably and resolved spontaneously after 1 month. The patient was referred to the internal medicine and ophthalmology departments, where systemic and ophthalmological involvement, respectively, were ruled out. Serological tests revealed that the patient was positive for anti-CMV immunoglobulin (Ig) G.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical picture was interpreted as likely reactivation of a CMV infection, with exclusively cutaneous involvement, in a patient with low-level immunosuppression secondary to treatment of the underlying disease.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">CMV, also known as human herpesvirus 5 (HHV-5), is a DNA virus belonging to the herpesvirus family. It is estimated that half of the general population comes into contact with this virus during their lifetime.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The virus is secreted in the bodily fluids of infected patients, and very close contact between individuals is required for transmission.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> After primary infection, which can be symptomatic or asymptomatic, patients generate anti-CMV antibodies that persist for life. The virus can remain latent, reactivating in response to immunosuppression, particularly cellular immunosuppression. Circulating antibodies against CMV are found in 30% to 50% of adults in Spain. This percentage is higher in developing countries, homosexual populations, and patients with human immunodeficiency virus (HIV).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In immunocompromised patients, CMV most often affects the respiratory, digestive, and central nervous systems; skin involvement is rare, and is usually an indicator of severe and generalized disease, with a mortality rate of over 80%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">CMV infection predominantly affects the genitoperineal area,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,5,6</span></a> and has a highly variable clinical presentation (papules, nodules, verrucous plaques, vesicles, purpura, and ulcerations), which is secondary to the direct cytopathic effect of the virus on the endothelial cells of the dermis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Diagnosis is established mainly based on histology, which reveals giant cytomegalic endothelial cells with large, basophilic, intranuclear inclusions surrounded by a clear halo (owl's-eye cells).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,4</span></a> Immunostaining with anti-CMV monoclonal antibody can be very useful.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Serology can help distinguish primary infection from reactivation, but is less useful in HIV-positive patients, in whom anti-CMV IgM antibodies are detected in both cases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> While cell culture and immunohistochemical techniques are also useful, PCR is the gold standard diagnostic technique owing to its high sensitivity and specificity.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Early treatment of affected patients with ganciclovir can reduce morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In immunocompetent hosts, CMV infection can be oligosymptomatic (90%) or can give rise to a mononucleosis-like presentation characterized by fever, chills, hepatic alterations, and atypical lymphocytosis, in some cases accompanied by a rubelliform rash. Isolated skin involvement, which is even more rare, typically occurs in patients with primary CMV infection, and has a good prognosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 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 and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => 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: Martínez-González MI, Goula-Fernández S, González-Pérez R. Úlceras en abdomen. Actas Dermosifiliogr. 2019;110:311–312.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 505 "Ancho" => 650 "Tamanyo" => 39444 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 41577 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 745 "Ancho" => 1500 "Tamanyo" => 229738 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.1. B, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>65.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "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" => "Infección por citomegalovirus. Atención a sus manifestaciones cutáneas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. Viglioglia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Act Terap Dermatol" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "298" "paginaFinal" => "302" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inmunohistoquímica en el diagnóstico de las infecciones virales cutáneas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M. Molina-Ruiz" 1 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "31" "paginaFinal" => "42" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestaciones cutáneas de la infección por citomegalovirus en un paciente con compromiso inmunitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Bolivar" 1 => "M.A. Ocampo" 2 => "M. Rolón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Colomb Dermatol" "fecha" => "2010" "volumen" => "18" "paginaInicial" => "245" "paginaFinal" => "247" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous cytomegalovirus infection in an immunocompetent patient: Innocent bystander or culprit?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Grushchak" 1 => "K.A. Hutchens" 2 => "C. Joy" 3 => "A. Peterson" 4 => "J. Speiser" 5 => "K. Mudaliar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000001009" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2018" "volumen" => "40" "paginaInicial" => "295" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28937438" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytomegalovirus ulcer. Successful treatment with valganciclovir" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.M. Lambert" 1 => "J. Strasswimmer" 2 => "R. Lazova" 3 => "R.J. Antaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.10.1199" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "1199" "paginaFinal" => "1201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15492181" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of cutaneous cytomegalovirus infection in non-acquired immune deficiency syndrome, immunocompromised patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.L. Choi" 1 => "J.A. Kim" 2 => "K.T. Jang" 3 => "D.S. Kim" 4 => "W.S. Kim" 5 => "J.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07456.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2006" "volumen" => "155" "paginaInicial" => "977" "paginaFinal" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17034528" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000004/v1_201905070820/S1578219019300940/v1_201905070820/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/15782190/0000011000000004/v1_201905070820/S1578219019300940/v1_201905070820/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300940?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 6 | 17 |
| 2024 Octubre | 67 | 60 | 127 |
| 2024 Septiembre | 59 | 25 | 84 |
| 2024 Agosto | 81 | 73 | 154 |
| 2024 Julio | 55 | 39 | 94 |
| 2024 Junio | 55 | 31 | 86 |
| 2024 Mayo | 65 | 38 | 103 |
| 2024 Abril | 63 | 37 | 100 |
| 2024 Marzo | 59 | 26 | 85 |
| 2024 Febrero | 54 | 45 | 99 |
| 2024 Enero | 52 | 35 | 87 |
| 2023 Diciembre | 38 | 15 | 53 |
| 2023 Noviembre | 54 | 31 | 85 |
| 2023 Octubre | 55 | 21 | 76 |
| 2023 Septiembre | 46 | 28 | 74 |
| 2023 Agosto | 23 | 16 | 39 |
| 2023 Julio | 41 | 34 | 75 |
| 2023 Junio | 35 | 26 | 61 |
| 2023 Mayo | 41 | 20 | 61 |
| 2023 Abril | 33 | 16 | 49 |
| 2023 Marzo | 37 | 26 | 63 |
| 2023 Febrero | 28 | 25 | 53 |
| 2023 Enero | 42 | 23 | 65 |
| 2022 Diciembre | 36 | 37 | 73 |
| 2022 Noviembre | 25 | 29 | 54 |
| 2022 Octubre | 28 | 22 | 50 |
| 2022 Septiembre | 27 | 32 | 59 |
| 2022 Agosto | 25 | 39 | 64 |
| 2022 Julio | 20 | 29 | 49 |
| 2022 Junio | 35 | 26 | 61 |
| 2022 Mayo | 26 | 38 | 64 |
| 2022 Abril | 33 | 26 | 59 |
| 2022 Marzo | 38 | 47 | 85 |
| 2022 Febrero | 33 | 23 | 56 |
| 2022 Enero | 33 | 32 | 65 |
| 2021 Diciembre | 28 | 44 | 72 |
| 2021 Noviembre | 41 | 34 | 75 |
| 2021 Octubre | 31 | 49 | 80 |
| 2021 Septiembre | 29 | 32 | 61 |
| 2021 Agosto | 25 | 29 | 54 |
| 2021 Julio | 22 | 24 | 46 |
| 2021 Junio | 19 | 23 | 42 |
| 2021 Mayo | 28 | 41 | 69 |
| 2021 Abril | 39 | 82 | 121 |
| 2021 Marzo | 46 | 17 | 63 |
| 2021 Febrero | 54 | 26 | 80 |
| 2021 Enero | 36 | 9 | 45 |
| 2020 Diciembre | 34 | 11 | 45 |
| 2020 Noviembre | 19 | 15 | 34 |
| 2020 Octubre | 21 | 10 | 31 |
| 2020 Septiembre | 20 | 16 | 36 |
| 2020 Agosto | 17 | 10 | 27 |
| 2020 Julio | 18 | 9 | 27 |
| 2020 Junio | 30 | 15 | 45 |
| 2020 Mayo | 13 | 9 | 22 |
| 2020 Abril | 10 | 9 | 19 |
| 2020 Marzo | 12 | 5 | 17 |
| 2020 Febrero | 1 | 1 | 2 |
| 2019 Mayo | 4 | 0 | 4 |
Mostrar todo
