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1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Based on the patient&#8217;s clinical picture a suspected diagnosis of heparin-induced skin necrosis was established&#46; Laboratory tests&#44; including a complete blood count and coagulation parameters&#44; revealed no findings of interest&#44; apart from thrombocytopenia &#40;107<span class="elsevierStyleHsp" style=""></span>000 platelets&#47;mL&#41;&#46; Tests for anti-platelet factor 4 antibodies were negative&#46; Heparin treatment was immediately discontinued and oral anticoagulation treatment with warfarin was initiated&#46; Fifteen days after heparin discontinuation a clear improvement in the patient&#8217;s lesions was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and the platelet count returned to 130<span class="elsevierStyleHsp" style=""></span>000 platelets&#47;mL&#46; Skin necrosis in response to anticoagulant treatment is a rare adverse reaction&#44; and is rarer in patients treated with heparin than in those treated with oral anticoagulants &#40;0&#46;01&#37; of patients&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the pathogenesis of this adverse effect is unclear&#44; most authors suspect an immune mechanism whereby heparin-induced production of anti-platelet antibodies triggers platelet aggregation and consequent vascular occlusion&#46; Heparin-induced skin necrosis is considered part of heparin-induced thrombocytopenia syndrome&#44; although a decrease in platelet count is observed in only 50&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Clinical signs appear between 5 and 15 days after beginning treatment&#44; usually close to the injection site&#44; although rarer cases involving lesions at a distance from the injection site have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Lesions initially appear as painful&#44; well-delimited erythematous or hemorrhagic macules that become indurated over the following days&#46; Subsequently&#44; the lesions become necrotic and give way to tense&#44; painful serosanguineous sores and blisters that evolve into marked necrosis of the skin and subcutaneous cellular tissue&#46; In addition to marked necrotic lesions&#44; affected patients may present with other abortive erythematous or cyanotic lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests typically reveal thrombocytopenia and the presence of anti-platelet factor IV antibodies&#44; although their absence is insufficient to rule out heparin-induced skin necrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis is mainly clinical&#44; with histological confirmation in doubtful cases&#46; The main differential diagnoses are warfarin-induced skin necrosis and heparin-induced type-IV hypersensitivity reaction&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment consists of immediate discontinuation of heparin administration and replacement with other anticoagulants such as direct thrombin inhibitors &#40;hirudins&#41; or warfarin&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Substitution with other LMWHs is not recommended&#46; Discontinuation of heparin treatment is followed by rapid recovery of the platelet count and progressive healing of necrotic lesions&#44; as occurred in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common adverse effects of heparin include bleeding&#44; alopecia &#40;in up to 50&#37; of patients undergoing prolonged treatment&#41;&#44; osteoporosis&#44; hypersensitivity phenomena&#44; and thrombocytopenia&#46; Skin necrosis is a rare adverse reaction to heparin&#44; but should be taken into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Diagnosis is primarily clinical&#44; and early withdrawal of heparin treatment is essential to avoid the development of potentially fatal visceral thrombotic complications&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                    0 => array:2 [
                      "titulo" => "Necrosis cut&#225;nea por tratamiento anticoagulante oral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Andres"
                            1 => "R&#46; Malao"
                            2 => "L&#46; Gonzalo"
                            3 => "A&#46; Siegel"
                            4 => "V&#46; Gaete"
                            5 => "C&#46; Vergara"
                          ]
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                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Chil Cir"
                        "fecha" => "2011"
                        "volumen" => "63"
                        "paginaInicial" => "200"
                        "paginaFinal" => "203"
                      ]
                    ]
                  ]
                ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrosis cut&#225;nea por heparina&#58; una forma posiblemente fatal de hipersensibilidad a la heparina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Campo"
                            1 => "J&#46; Gonz&#225;lez Castro"
                            2 => "J&#46; Soler"
                            3 => "L&#46; G&#243;mez"
                            4 => "J&#46; Piulachs"
                            5 => "J&#46; Palou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1998"
                        "volumen" => "89"
                        "paginaInicial" => "613"
                        "paginaFinal" => "619"
                      ]
                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Low molecular weight heparin-induced skin necrosis occurring distant from injection sites and without thrombocytopenia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46;J&#46; Tietge"
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                            2 => "E&#46; J&#228;ckel"
                            3 => "C&#46; Trautwein"
                            4 => "M&#46;P&#46; Manns"
                          ]
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                    ]
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                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9627146"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic challenge of heparin-induced skin necrosis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;K&#46; Gan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Clin Lab Res"
                        "fecha" => "2017"
                        "volumen" => "5"
                        "paginaInicial" => "213"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
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                          "autores" => array:2 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
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                        "paginaFinal" => "363"
                      ]
                    ]
                  ]
                ]
              ]
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            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Widespread skin necrosis asociated with unfractioned heparin therapy in a patient under chronic coumarin anticoagulation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;S&#46; S&#225;nchez"
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                            3 => "L&#46; Borradori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2006.01427.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
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                        "link" => array:1 [
                          0 => array:2 [
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                ]
              ]
            ]
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                      "titulo" => "Occlusive nonvasculitic vasculopathy&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "M&#46; Llamas-Velasco"
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                            2 => "A&#46; Santos-Briz"
                            3 => "L&#46; Cerroni"
                            4 => "H&#46; Kutzner"
                            5 => "L&#46; Requena"
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                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:5 [
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Case and Research Letters
Heparin-Induced Skin Necrosis Occurring at a Distance From Injection Sites
Necrosis cutánea por heparina con afectación a distancia del punto de administración
A. Estébanez
Autor para correspondencia
andreaestebanez_7@hotmail.com

Corresponding author.
, E. Silva, P. Cordero, J.M. Martín
Servicio de Dermatología, Hospital Clínico Universitario, Valencia, Spain
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    "titulo" => "Heparin-Induced Skin Necrosis Occurring at a Distance From Injection Sites"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 67-year-old man who had been diagnosed 1 year earlier with inoperable glioblastoma multiforme that was refractory to multiple treatments was treated with low-molecular-weight heparin &#40;LMWH&#41; after an episode of pulmonary thromboembolism and deep venous thrombosis&#46; Disseminated asymptomatic skin lesions appeared 5 days after beginning LMWH therapy&#46; Despite the spectacular appearance of the skin lesions the patient&#8217;s general condition was excellent&#46; Fever and other clinical signs of infection were absent&#46; Physical examination revealed large&#44; noninfiltrated ecchymotic plaques located mainly on the abdomen without underlying fluid collection &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; necrotic lesions on the right thigh &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; and tense blisters with hemorrhagic content in the distal area of the right leg &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Based on the patient&#8217;s clinical picture a suspected diagnosis of heparin-induced skin necrosis was established&#46; Laboratory tests&#44; including a complete blood count and coagulation parameters&#44; revealed no findings of interest&#44; apart from thrombocytopenia &#40;107<span class="elsevierStyleHsp" style=""></span>000 platelets&#47;mL&#41;&#46; Tests for anti-platelet factor 4 antibodies were negative&#46; Heparin treatment was immediately discontinued and oral anticoagulation treatment with warfarin was initiated&#46; Fifteen days after heparin discontinuation a clear improvement in the patient&#8217;s lesions was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and the platelet count returned to 130<span class="elsevierStyleHsp" style=""></span>000 platelets&#47;mL&#46; Skin necrosis in response to anticoagulant treatment is a rare adverse reaction&#44; and is rarer in patients treated with heparin than in those treated with oral anticoagulants &#40;0&#46;01&#37; of patients&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the pathogenesis of this adverse effect is unclear&#44; most authors suspect an immune mechanism whereby heparin-induced production of anti-platelet antibodies triggers platelet aggregation and consequent vascular occlusion&#46; Heparin-induced skin necrosis is considered part of heparin-induced thrombocytopenia syndrome&#44; although a decrease in platelet count is observed in only 50&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Clinical signs appear between 5 and 15 days after beginning treatment&#44; usually close to the injection site&#44; although rarer cases involving lesions at a distance from the injection site have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Lesions initially appear as painful&#44; well-delimited erythematous or hemorrhagic macules that become indurated over the following days&#46; Subsequently&#44; the lesions become necrotic and give way to tense&#44; painful serosanguineous sores and blisters that evolve into marked necrosis of the skin and subcutaneous cellular tissue&#46; In addition to marked necrotic lesions&#44; affected patients may present with other abortive erythematous or cyanotic lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests typically reveal thrombocytopenia and the presence of anti-platelet factor IV antibodies&#44; although their absence is insufficient to rule out heparin-induced skin necrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis is mainly clinical&#44; with histological confirmation in doubtful cases&#46; The main differential diagnoses are warfarin-induced skin necrosis and heparin-induced type-IV hypersensitivity reaction&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment consists of immediate discontinuation of heparin administration and replacement with other anticoagulants such as direct thrombin inhibitors &#40;hirudins&#41; or warfarin&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Substitution with other LMWHs is not recommended&#46; Discontinuation of heparin treatment is followed by rapid recovery of the platelet count and progressive healing of necrotic lesions&#44; as occurred in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common adverse effects of heparin include bleeding&#44; alopecia &#40;in up to 50&#37; of patients undergoing prolonged treatment&#41;&#44; osteoporosis&#44; hypersensitivity phenomena&#44; and thrombocytopenia&#46; Skin necrosis is a rare adverse reaction to heparin&#44; but should be taken into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Diagnosis is primarily clinical&#44; and early withdrawal of heparin treatment is essential to avoid the development of potentially fatal visceral thrombotic complications&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Andres"
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                            2 => "L&#46; Gonzalo"
                            3 => "A&#46; Siegel"
                            4 => "V&#46; Gaete"
                            5 => "C&#46; Vergara"
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                      "titulo" => "Necrosis cut&#225;nea por heparina&#58; una forma posiblemente fatal de hipersensibilidad a la heparina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Campo"
                            1 => "J&#46; Gonz&#225;lez Castro"
                            2 => "J&#46; Soler"
                            3 => "L&#46; G&#243;mez"
                            4 => "J&#46; Piulachs"
                            5 => "J&#46; Palou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "1998"
                        "volumen" => "89"
                        "paginaInicial" => "613"
                        "paginaFinal" => "619"
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0015"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Low molecular weight heparin-induced skin necrosis occurring distant from injection sites and without thrombocytopenia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46;J&#46; Tietge"
                            1 => "H&#46;H&#46; Schmidt"
                            2 => "E&#46; J&#228;ckel"
                            3 => "C&#46; Trautwein"
                            4 => "M&#46;P&#46; Manns"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2796.1998.00304.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intern Med"
                        "fecha" => "1998"
                        "volumen" => "243"
                        "paginaInicial" => "313"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9627146"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic challenge of heparin-induced skin necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;K&#46; Gan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Clin Lab Res"
                        "fecha" => "2017"
                        "volumen" => "5"
                        "paginaInicial" => "213"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrosis cut&#225;nea por heparina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Dom&#237;nguez Espinosa"
                            1 => "M&#46; D&#237;az Madrid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "362"
                        "paginaFinal" => "363"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Widespread skin necrosis asociated with unfractioned heparin therapy in a patient under chronic coumarin anticoagulation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;S&#46; S&#225;nchez"
                            1 => "S&#46;A&#46; Angelillo"
                            2 => "I&#46; Masouy&#233;"
                            3 => "L&#46; Borradori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2006.01427.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "327"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16503898"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Occlusive nonvasculitic vasculopathy&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Llamas-Velasco"
                            1 => "V&#46; Alegria"
                            2 => "A&#46; Santos-Briz"
                            3 => "L&#46; Cerroni"
                            4 => "H&#46; Kutzner"
                            5 => "L&#46; Requena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Dermatopathol"
                        "fecha" => "2016"
                        "volumen" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "25"
                      ]
                    ]
                  ]
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