Case and Research Letters
Primary Cutaneous Nocardiosis in a Man Treated With Certolizumab
Nocardiosis cutánea primaria en un paciente en tratamiento con certolizumab
Leído
5808
Vecesse ha leído el artículo
2026
Total PDF
3782
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219019302355" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.07.008" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2151" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:698-700" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731019300626" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.04.011" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2151" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:698-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 140 "formatos" => array:2 [ "HTML" => 112 "PDF" => 28 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICO-CLÍNICA</span>" "titulo" => "Nocardiosis cutánea primaria en un paciente en tratamiento con certolizumab" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "698" "paginaFinal" => "699" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary Cutaneous Nocardiosis in a Man Treated With Certolizumab" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 678 "Ancho" => 900 "Tamanyo" => 269790 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El estudio histopatológico que muestra un infiltrado inflamatorio neutrofílico superficial y profundo formando abscesos focales en la dermis (hematoxilina-eosina ×10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Gil Redondo, V. Melgar Molero, A. Martín Fuentes, E. de Eusebio Murillo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Gil Redondo" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Melgar Molero" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martín Fuentes" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "de Eusebio Murillo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019302355" "doi" => "10.1016/j.adengl.2019.07.008" "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/S1578219019302355?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019300626?idApp=UINPBA000044" "url" => "/00017310/0000011000000008/v1_201910020711/S0001731019300626/v1_201910020711/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019302343" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.07.007" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2148" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:700-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Levofloxacin-Induced Hyperpigmentation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "700" "paginaFinal" => "702" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpigmentación inducida por levofloxacino" ] ] "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" => 463 "Ancho" => 1255 "Tamanyo" => 298543 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Abundant siderophages in the deepest areas of the dermis (hematoxylin-eosin, original magnification ×20). Cytoplasm containing slightly refringent golden-brown granules. B, Positive Perls staining (iron), revealing bluish, granular cytoplasm inside the macrophages.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Castellanos-González, M.L. González Morales, J. González-Granda Villalobos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Castellanos-González" ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "González Morales" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "González-Granda Villalobos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019300596" "doi" => "10.1016/j.ad.2018.04.010" "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/S0001731019300596?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302343?idApp=UINPBA000044" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302343/v1_201910050935/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157821901930232X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.02.027" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "2098" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:696-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Pemphigoid Gestationis Mimicking Erythema Multiforme With Mucosal Involvement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "696" "paginaFinal" => "697" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Penfigoide gestacional simulando un eritema multiforme con afectación mucosa" ] ] "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" => 1246 "Ancho" => 1667 "Tamanyo" => 312937 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exudative erythema multiforme-like lesions on the skin and oral erosions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lobato-Berezo, M.T. Fernández Figueras, J.A. Moreno Romero, R.M. Pujol" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Fernández Figueras" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Moreno Romero" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018304952" "doi" => "10.1016/j.ad.2018.02.038" "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/S0001731018304952?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930232X?idApp=UINPBA000044" "url" => "/15782190/0000011000000008/v1_201910050935/S157821901930232X/v1_201910050935/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Primary Cutaneous Nocardiosis in a Man Treated With Certolizumab" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "698" "paginaFinal" => "700" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Gil Redondo, V. Melgar Molero, A. Martín Fuentes, E. de Eusebio Murillo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Gil Redondo" "email" => array:1 [ 0 => "rociogilredondo@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" => "V." "apellidos" => "Melgar Molero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Martín Fuentes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "de Eusebio Murillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Sanitas La Moraleja, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nocardiosis cutánea primaria en un paciente en tratamiento con certolizumab" ] ] "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" => 678 "Ancho" => 900 "Tamanyo" => 269881 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealing a superficial and deep neutrophilic inflammatory infiltrate forming focal dermal abscesses (hematoxylin-eosin, original magnification ×10).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biologic therapies are increasingly used to treat many inflammatory conditions, including skin diseases. Adverse effects include infections, some of which are potentially serious.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 53-year-old male livestock worker with psoriatic arthritis, for which he had been treated with leflunomide (5 years) and certolizumab (2 years), presented with an asymptomatic lesion on the wrist that had appeared 15 days earlier and had not responded to a 1-week course of oral clarithromycin (500<span class="elsevierStyleHsp" style=""></span>mg/12 h) and topical fusidic acid therapy. The patient reported neither fever nor systemic symptoms. Physical examination revealed an indurated, erythematous-violaceous nodule (2<span class="elsevierStyleHsp" style=""></span>cm in diameter) with a central crust on the dorsum of the left wrist (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A swab sample was collected from the lesion surface for culture and a skin biopsy was taken for culture and histopathology.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The biopsy showed a superficial and deep predominantly neutrophilic inflammatory infiltrate that formed focal dermal abscesses. No nuclear pseudoinclusions were observed. Periodic acid-Schiff (PAS) and silver staining were negative (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The swab culture was negative, but <span class="elsevierStyleItalic">Nocardia brasiliensis</span> resistant to clarithromycin and sensitive to trimethoprim/sulfamethoxazole was isolated from the skin biopsy culture (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A basic battery of tests and pulmonary and brain computed tomography (CT) revealed no findings of note. The patient was diagnosed with localized primary cutaneous nocardiosis. After discontinuing certolizumab treatment, he began treatment with trimethoprim/sulfamethoxazole (80<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h and 400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, respectively), which resulted in complete lesion resolution in 6 months.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Nocardiosis is a rare infection that most often affects immunocompromised patients, and is considered an emerging infectious disease by some authors.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Cutaneous nocardiosis accounts for up to 25% of cases and can lead to disseminated disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> It is caused by direct inoculation, mainly by <span class="elsevierStyleItalic">N brasiliensis</span>. The localized cutaneous form can be indistinguishable from other pyodermas and in one third of cases evolves to a lymphocutaneous form, with formation of nodules along the lymphatic pathway.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The differential diagnosis includes bacterial (erysipeloid, tularemia, and anthrax), fungal (sporotrichosis), and viral (Orf and milker's nodules) infections, as well as atypical mycobacterial infections and leishmaniasis. A secondary form of nocardiosis, caused by hematogenous seeding from another focus, can resemble the primary form and can cause significant morbidity and mortality. Diagnosis is established by culture of samples acquired by invasive methods such as biopsy or aspiration of pus. In cases of clinical suspicion of nocardiosis the microbiologist should be notified in advance to ensure culture of the sample in the appropriate medium.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Because sensitivity profiles differ between species, it is advisable to perform an antibiogram.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Histopathology reveals nonspecific changes and silver staining occasionally enables visualization of the microorganisms.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> In patients with cutaneous nocardiosis, especially immunocompromised patients, systemic disease should be ruled out by pulmonary and cerebral CT.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Tumor necrosis factor α (TNF-α) plays an important role in immunity against intracellular pathogens such as <span class="elsevierStyleItalic">Nocardia</span> species.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Of the 11 reported cases of nocardiosis in patients receiving anti-TNF therapy, 3 involved patients with primary cutaneous nocardiosis<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4,8</span></a> and none were associated with certolizumab treatment. Singh and coworkers described a case of cutaneous nocardiosis in a 45-year-old patient with Crohn disease who was being treated with prednisone and infliximab.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Ali et al reported the case of a 61-year-old Crohn disease patient who was being treated with infliximab.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In both cases, the causative species could not be identified. Fabre et al described the case of a 70-year-old rheumatoid arthritis patient who was being treated with infliximab, methotrexate, and corticosteroids, and who developed primary cutaneous nocardiosis due to <span class="elsevierStyleItalic">Nocardia otitidiscaviarum</span>.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In none of the aforementioned cases were systemic symptoms or disseminated disease observed. All patients progressed favorably after discontinuing anti-TNF treatment and beginning treatment with trimethoprim/sulfamethoxazole<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a> or ofloxacin and clindamycin.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Although leflunomide has been associated with the development of intracellular pathogen infections, to our knowledge no cases of leflunomide-associated nocardiosis have been reported. Compared with other disease-modifying antirheumatic drugs, anti-TNF therapy is associated with an increased risk of skin and soft tissue infections.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Based on this association and the sequence of clinical events in the current case, we believe that certolizumab was the main determinant of our patient's condition.</p><p id="par0030" class="elsevierStylePara elsevierViewall">While there is currently insufficient evidence to recommend a specific drug regimen and treatment duration, trimethoprim/sulfamethoxazole therapy for 3 to 12 months is considered the treatment of choice, depending on the patient's immune status, and desensitization therapy is recommended in cases of allergy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Localized forms of nocardiosis can be surgically removed to shorten the treatment duration.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Immunosuppressive drug treatment should be withdrawn or continued at the minimum dose. A lack of improvement after 2 weeks can indicate resistance, poor tissue penetration, or the need for surgical drainage. It should be noted that clinical suspicion is fundamental for early diagnosis and treatment, and for early withdrawal of anti-TNF therapy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,6</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:2 [ "identificador" => "xack429035" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-12" "fechaAceptado" => "2018-04-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gil Redondo R, Melgar Molero V, Martín Fuentes A, de Eusebio Murillo E. Nocardiosis cutánea primaria en un paciente en tratamiento con certolizumab. Actas Dermosifiliogr. 2019;110:698–699.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 146476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated, erythematous-violaceous nodule with a central crust on the dorsum of the wrist.</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" => 678 "Ancho" => 900 "Tamanyo" => 269881 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealing a superficial and deep neutrophilic inflammatory infiltrate forming focal dermal abscesses (hematoxylin-eosin, original magnification ×10).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 677 "Ancho" => 1733 "Tamanyo" => 104794 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Gram staining revealing gram-positive coccobacilli forming branched filaments. B, <span class="elsevierStyleItalic">Nocardia brasiliensis</span> colonies growing in blood agar culture.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infection risk with biologic therapy in patients with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Hindryckx" 1 => "G. Novak" 2 => "S. Bonovas" 3 => "L. Peyrin-Biroulet" 4 => "S. Danese" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cpt.791" "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther." "fecha" => "2017" "volumen" => "102" "paginaInicial" => "633" "paginaFinal" => "641" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28699217" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of nocardial infections with anti-tumor necrosis factor therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Ali" 1 => "A. Chakraburtty" 2 => "S. Mahmood" 3 => "M.S. Bronze" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MAJ.0b013e3182883708" "Revista" => array:6 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2013" "volumen" => "346" "paginaInicial" => "166" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23531994" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nocardia infections among immunomodulated inflammatory bowel disease patients: A review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Abreu" 1 => "N. Rocha-Pereira" 2 => "A. Sarmento" 3 => "F. Magro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v21.i21.6491" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "6491" "paginaFinal" => "6498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26074688" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous Nocardia otitidiscaviarum infection in a patient with rheumatoid arthritis treated with infliximab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Fabre" 1 => "C. Gibert" 2 => "C. Lechiche" 3 => "C. Jorgensen" 4 => "J. Sany" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "2432" "paginaFinal" => "2433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16331777" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nocardiosis cutánea y sus formas clínicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.M. Guzzi" 1 => "D.F. Malieni" 2 => "A.C. Torre" 3 => "R. Galimberti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Argent" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "195" "paginaFinal" => "198" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cutaneous Nocardia brasiliensis infection isolated in an immunosuppressed patient: A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.W. Lai" 1 => "L.A. Brodell" 2 => "E. Lambert" 3 => "M. Menegus" 4 => "G.A. Scott" 5 => "J.H. Tu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2012" "volumen" => "89" "paginaInicial" => "75" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22474729" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro activities of tigecycline and eight other antimicrobials against different Nocardia species identified by molecular methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Cercenado" 1 => "M. Marín" 2 => "M. Sánchez-Martínez" 3 => "O. Cuevas" 4 => "J. Martínez-Alarcón" 5 => "E. Bouza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.01102-06" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2007" "volumen" => "51" "paginaInicial" => "1102" "paginaFinal" => "1104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17194827" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Singh" 1 => "N.V. Rau" 2 => "L.B. Cohen" 3 => "H. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.1040563" "Revista" => array:6 [ "tituloSerie" => "CMAJ" "fecha" => "2004" "volumen" => "171" "paginaInicial" => "1063" "paginaFinal" => "1064" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15505269" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rates of serious infection, including site- specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: Results from the British Society for Rheumatology Biologics Register" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "British Society for Rheumatology Biologics Register" "etal" => false "autores" => array:6 [ 0 => "W.G. Dixon" 1 => "K. Watson" 2 => "M. Lunt" 3 => "K.L. Hyrich" 4 => "A.J. Silman" 5 => "D.P. Symmons" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.21978" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "2368" "paginaFinal" => "2376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16868999" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack429035" "titulo" => "Acknowledgments" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The authors thank Dr. Daniel Tena Gómez (Microbiology Department), Dr. Itziar Eraña Tomás and Dr. Jesús Cuevas Santos (Pathological Anatomy Department), and Dr. Esteban Martín Echevarría (Internal Medicine Department) of the University Hospital of Guadalajara for their assistance with the diagnosis and the writing of the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000008/v1_201910050935/S1578219019302355/v1_201910050935/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/15782190/0000011000000008/v1_201910050935/S1578219019302355/v1_201910050935/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302355?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 17 | 26 |
| 2024 Octubre | 81 | 87 | 168 |
| 2024 Septiembre | 77 | 59 | 136 |
| 2024 Agosto | 109 | 74 | 183 |
| 2024 Julio | 88 | 64 | 152 |
| 2024 Junio | 81 | 42 | 123 |
| 2024 Mayo | 82 | 43 | 125 |
| 2024 Abril | 79 | 30 | 109 |
| 2024 Marzo | 111 | 24 | 135 |
| 2024 Febrero | 140 | 40 | 180 |
| 2024 Enero | 120 | 33 | 153 |
| 2023 Diciembre | 106 | 22 | 128 |
| 2023 Noviembre | 121 | 43 | 164 |
| 2023 Octubre | 96 | 37 | 133 |
| 2023 Septiembre | 85 | 28 | 113 |
| 2023 Agosto | 67 | 22 | 89 |
| 2023 Julio | 94 | 47 | 141 |
| 2023 Junio | 71 | 32 | 103 |
| 2023 Mayo | 100 | 49 | 149 |
| 2023 Abril | 90 | 30 | 120 |
| 2023 Marzo | 72 | 29 | 101 |
| 2023 Febrero | 60 | 34 | 94 |
| 2023 Enero | 52 | 42 | 94 |
| 2022 Diciembre | 65 | 39 | 104 |
| 2022 Noviembre | 40 | 31 | 71 |
| 2022 Octubre | 42 | 27 | 69 |
| 2022 Septiembre | 39 | 49 | 88 |
| 2022 Agosto | 27 | 35 | 62 |
| 2022 Julio | 24 | 45 | 69 |
| 2022 Junio | 16 | 31 | 47 |
| 2022 Mayo | 73 | 41 | 114 |
| 2022 Abril | 81 | 29 | 110 |
| 2022 Marzo | 87 | 47 | 134 |
| 2022 Febrero | 76 | 26 | 102 |
| 2022 Enero | 86 | 41 | 127 |
| 2021 Diciembre | 52 | 37 | 89 |
| 2021 Noviembre | 61 | 50 | 111 |
| 2021 Octubre | 70 | 54 | 124 |
| 2021 Septiembre | 49 | 48 | 97 |
| 2021 Agosto | 66 | 30 | 96 |
| 2021 Julio | 62 | 30 | 92 |
| 2021 Junio | 45 | 23 | 68 |
| 2021 Mayo | 68 | 42 | 110 |
| 2021 Abril | 186 | 119 | 305 |
| 2021 Marzo | 73 | 23 | 96 |
| 2021 Febrero | 62 | 28 | 90 |
| 2021 Enero | 49 | 18 | 67 |
| 2020 Diciembre | 25 | 12 | 37 |
| 2020 Noviembre | 39 | 19 | 58 |
| 2020 Octubre | 22 | 13 | 35 |
| 2020 Septiembre | 32 | 8 | 40 |
| 2020 Agosto | 33 | 36 | 69 |
| 2020 Julio | 25 | 11 | 36 |
| 2020 Junio | 24 | 24 | 48 |
| 2020 Mayo | 33 | 11 | 44 |
| 2020 Abril | 21 | 11 | 32 |
| 2020 Marzo | 36 | 6 | 42 |
| 2020 Febrero | 2 | 4 | 6 |
Mostrar todo
