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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intravenous gamma globulin &#40;IVGG&#41; therapy is a treatment based on blood products obtained from multiple donations&#46; It has been used for decades to treat a variety of skin diseases&#44; including autoimmune blistering diseases&#44; some forms of collagenosis&#44; and severe toxic drug reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 60-year-old woman who had undergone surgery for ovarian adenocarcinoma and had rheumatoid arthritis&#44; for which she was in treatment with sulfasalazine and leflunomide&#46; She came to the emergency department with a cutaneous presentation that had appeared 72&#8239;hours earlier and consisted of oral discomfort and conjunctivitis&#44; followed by the appearance of target lesions in the cervical area and on both palms and soles&#46; In some areas&#44; including the labial submucosa&#44; the lesions caused erosions&#44; and tense blisters were observed on the acral surface&#46; The patient occasionally took paracetamol or tramadol&#44; had completed a cycle of amoxicillin&#47;clavulanic acid &#40;875&#47;125&#8239;mg for 2 months&#41;&#44; and during the preceding 2 weeks had been using Perio-Aid rinses &#40;0&#46;12&#37; chlorhexidine&#44; 0&#46;05&#37; cetylpyridinium chloride&#41; prescribed by her dentist&#46; She had been exposed once to Artinibsa &#40;articaine&#8239;&#43;&#8239;epinephrine&#44; 40&#8239;mg&#47;mL&#41;&#44; which was used as an anesthetic for a tooth extraction procedure&#46; Serology for <span class="elsevierStyleItalic">Mycoplasma</span> species was negative&#46; Based on a suspected diagnosis of Stevens-Johnson syndrome&#44; the patient was hospitalized in the dermatology ward for systemic treatment with prednisone &#40;1&#8239;mg&#47;kg&#47;d&#41;&#46; On the second day after admission&#44; the rash on the trunk&#44; neck&#44; and face became more pronounced&#44; and multiple erosive areas appeared&#44; for which she began IVGG treatment &#40;Plangamma&#174;&#44; 0&#46;4&#8239;g&#47;kg&#47;d&#41; for 5 days&#46; However&#44; on the day of completion of IVGG treatment&#44; the rash continued to progress and the erosive areas already exceeded 20&#8211;30&#37; of the body surface&#46; Blood was extracted for baseline blood tests and a single dose of etanercept &#40;50&#8239;mg&#41; was prescribed and administered without waiting for the blood test results&#46; Over the next 48&#8239;hours&#44; the patient&#8217;s general condition progressively improved&#44; and there was an evident interruption of the progression of her condition&#46; The serological findings indicated possible past hepatitis B virus &#40;HBV&#41; infection &#40;positive for hepatitis B core antibody &#91;HBcAb&#93; IgG and hepatitis B surface antibody &#91;HBsAb&#93;&#41; that had not been detected in blood tests performed 7 months earlier&#46; The patient was negative for hepatitis B surface antigen &#40;HBsAg&#41; and for hepatitis B viral DNA&#44; as evaluated by polymerase chain reaction&#46; The patient&#8217;s clinical history revealed no risk factors for HBV&#46; Therefore&#44; possible passive acquisition of HBcAb and HBsAb through IVGG therapy was suspected&#46; This suspicion was confirmed 6 weeks later when the patient tested negative for HBcAb&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Evaluation of HBsAg and viral DNA is mandatory for screening of HBV to prevent virus transmission in blood products&#46; However&#44; this analysis does not exclude donors with past HBV infections&#44; who can transmit their protective antibodies to IVGG recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact&#44; in a cohort of 80 patients treated with IVGG in which 9 patients were HBsAb-positive and 1 patient was a doubtful positive for HBcAb before receiving infusions&#44; the percentage of patients positive for HBsAb and HBcAb IgG increased to 99&#37; and 46&#37;&#44; respectively&#44; after treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A lack of knowledge of this condition can result in the incorrect diagnosis of IVGG recipients with latent infections&#44; leading to stress and unnecessary treatment<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;e&#46;g&#46; in patients who will subsequently be treated with rituximab for autoimmune blistering diseases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Another infection that can cause confusion is syphilis&#44; since IVGG infusions can contain antibodies that are identified in treponemal tests&#44; although reagin tests are always negative&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a> Cases have been described in which patients treated with IVGG have tested positive for<span class="elsevierStyleItalic">Toxoplasma</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and <span class="elsevierStyleItalic">Borrelia burgdoferi</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Positivity for pathogens against which the population is frequently immunized&#44; including varicella-zoster virus and parvovirus B19&#44; can also be expected after IVGG therapy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; in patients treated with IVGG&#44; positive microbiological serology results should be interpreted with caution&#46; For some pathogens&#44; such as <span class="elsevierStyleItalic">T pallidum</span>&#44; <span class="elsevierStyleItalic">B burgdorferi</span>&#44; and <span class="elsevierStyleItalic">Toxoplasma</span>&#44; serology should be repeated 4 to 8 weeks later &#40;the half-life of IgG is 3 weeks&#41; and again until values return to normal&#46; If available&#44; molecular diagnostic techniques &#40;e&#46;g&#46; HBV DNA detection&#41; should be requested&#44; as these can more quickly rule out an active infection&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Furthermore&#44; if IVGG is used to treat diseases that may subsequently require the use of biological drugs such as rituximab&#44; it may be advisable to have baseline serology data at hand&#44; as this will facilitate interpretation of the results of pretreatment screening studies after IVGG infusion&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Ab&#44; antibody&#59; Ag&#44; antigen&#59; CT&#44; computed tomography&#59; CSF&#44; cerebrospinal fluid&#59; EIA&#44; enzyme immunoassay&#59; FTA Abs&#44; fluorescent treponemal antibody absorption test&#59; GM&#44; galactomannan&#59; HBcAb&#44; hepatitis B core antibody&#59; HBsAb&#44; hepatitis B surface antibody&#59; IgG&#44; immunoglobulin G&#59; IVGG&#44; human intravenous gamma globulin&#59; PCR&#44; polymerase chain reaction&#59; RPR&#44; fast plasma reagin&#59; TPHA&#44; <span class="elsevierStyleItalic">Treponema pallidum</span> hemagglutination assay&#59; VDRL&#44; Venereal Disease Research Laboratory test&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serological Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microbiological Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic Approach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis B virus<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;7</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAb positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous hepatitis B infection</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Request PCR for viral DNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBcAb &#40;IgG&#41; positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repeat blood tests in 6&#8211;8 weeks</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Syphilis &#40;<span class="elsevierStyleItalic">T pallidum</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive treponemal tests &#40;EIA&#8239;&#177;&#8239;TPHA&#47;FTA Abs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treated syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repeat blood tests after several weeks&#46; There are no tests for direct diagnosis</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative RPR and VDRL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Late latent syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">B burgdorferi</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA positive for <span class="elsevierStyleItalic">Borrelia</span> IgG</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borreliosis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR for <span class="elsevierStyleItalic">Borrelia</span> in blood or CSF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repeat blood tests after several weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive aspergillosis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA positive for GM</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive <span class="elsevierStyleItalic">Aspergillus</span> infection in neutropenic patients with hematological fever</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR for <span class="elsevierStyleItalic">Aspergillus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA for GM &#40;bronchioalveolar lavage&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thoracic CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2586959.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive Serological Results Reported in Intravenous Gamma Globulin Recipients&#44; Microbiological Diagnosis That Patients Would Have Received if not Exposed to Gamma Globulins&#44; and Approach Taken to Verify a False-positive Caused by Passive Antibody Transfusion</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
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              "etiqueta" => "1"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                            0 => "F&#46;J&#46; Navarro-Trivi&#241;o"
                            1 => "I&#46; P&#233;rez-L&#243;pez"
                            2 => "R&#46; Ruiz-Villaverde"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
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                        "link" => array:1 [
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                            2 => "J&#46; Usher"
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                      "doi" => "10.7861/clinmedicine.15-2-125"
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                      "Revista" => array:7 [
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                            2 => "S&#46; Egami"
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                        "volumen" => "42"
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                      "doi" => "10.1043/0003-9985(2002)126<1237:PATAFI>2.0.CO;2"
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                        "volumen" => "126"
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                      "doi" => "10.1128/JCM.35.8.2187-2187.1997"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Luyasu"
                            1 => "S&#46; Mullier"
                            2 => "O&#46; Bauraind"
                            3 => "M&#46; Dupuis"
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                  ]
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                    0 => array:2 [
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                        "volumen" => "7"
                        "paginaInicial" => "697"
                        "paginaFinal" => "699"
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    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack528257"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">The authors thank the allergology service&#44; and especially Pilar Tornero for her tireless work with patients with allergic skin reactions&#46; Thanks also to the hospital&#8217;s intensive care service for their assistance in the management of this case&#46;</p>"
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Case and Research Letters
False-Positive Serology for Hepatitis B After Intravenous Immunoglobulin Therapy for Toxic Epidermal Necrolysis
Falsa positividad serológica para la hepatitis B tras el empleo de inmunoglobulinas intravenosas para una necrólisis epidérmica tóxica
A. Sánchez-Herrero
Autor para correspondencia
a.sanchez.herr@gmail.com

Corresponding author.
, L.M. Nieto-Benito, A.M. Rosell-Díaz, A. Pulido-Pérez
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intravenous gamma globulin &#40;IVGG&#41; therapy is a treatment based on blood products obtained from multiple donations&#46; It has been used for decades to treat a variety of skin diseases&#44; including autoimmune blistering diseases&#44; some forms of collagenosis&#44; and severe toxic drug reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 60-year-old woman who had undergone surgery for ovarian adenocarcinoma and had rheumatoid arthritis&#44; for which she was in treatment with sulfasalazine and leflunomide&#46; She came to the emergency department with a cutaneous presentation that had appeared 72&#8239;hours earlier and consisted of oral discomfort and conjunctivitis&#44; followed by the appearance of target lesions in the cervical area and on both palms and soles&#46; In some areas&#44; including the labial submucosa&#44; the lesions caused erosions&#44; and tense blisters were observed on the acral surface&#46; The patient occasionally took paracetamol or tramadol&#44; had completed a cycle of amoxicillin&#47;clavulanic acid &#40;875&#47;125&#8239;mg for 2 months&#41;&#44; and during the preceding 2 weeks had been using Perio-Aid rinses &#40;0&#46;12&#37; chlorhexidine&#44; 0&#46;05&#37; cetylpyridinium chloride&#41; prescribed by her dentist&#46; She had been exposed once to Artinibsa &#40;articaine&#8239;&#43;&#8239;epinephrine&#44; 40&#8239;mg&#47;mL&#41;&#44; which was used as an anesthetic for a tooth extraction procedure&#46; Serology for <span class="elsevierStyleItalic">Mycoplasma</span> species was negative&#46; Based on a suspected diagnosis of Stevens-Johnson syndrome&#44; the patient was hospitalized in the dermatology ward for systemic treatment with prednisone &#40;1&#8239;mg&#47;kg&#47;d&#41;&#46; On the second day after admission&#44; the rash on the trunk&#44; neck&#44; and face became more pronounced&#44; and multiple erosive areas appeared&#44; for which she began IVGG treatment &#40;Plangamma&#174;&#44; 0&#46;4&#8239;g&#47;kg&#47;d&#41; for 5 days&#46; However&#44; on the day of completion of IVGG treatment&#44; the rash continued to progress and the erosive areas already exceeded 20&#8211;30&#37; of the body surface&#46; Blood was extracted for baseline blood tests and a single dose of etanercept &#40;50&#8239;mg&#41; was prescribed and administered without waiting for the blood test results&#46; Over the next 48&#8239;hours&#44; the patient&#8217;s general condition progressively improved&#44; and there was an evident interruption of the progression of her condition&#46; The serological findings indicated possible past hepatitis B virus &#40;HBV&#41; infection &#40;positive for hepatitis B core antibody &#91;HBcAb&#93; IgG and hepatitis B surface antibody &#91;HBsAb&#93;&#41; that had not been detected in blood tests performed 7 months earlier&#46; The patient was negative for hepatitis B surface antigen &#40;HBsAg&#41; and for hepatitis B viral DNA&#44; as evaluated by polymerase chain reaction&#46; The patient&#8217;s clinical history revealed no risk factors for HBV&#46; Therefore&#44; possible passive acquisition of HBcAb and HBsAb through IVGG therapy was suspected&#46; This suspicion was confirmed 6 weeks later when the patient tested negative for HBcAb&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Evaluation of HBsAg and viral DNA is mandatory for screening of HBV to prevent virus transmission in blood products&#46; However&#44; this analysis does not exclude donors with past HBV infections&#44; who can transmit their protective antibodies to IVGG recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact&#44; in a cohort of 80 patients treated with IVGG in which 9 patients were HBsAb-positive and 1 patient was a doubtful positive for HBcAb before receiving infusions&#44; the percentage of patients positive for HBsAb and HBcAb IgG increased to 99&#37; and 46&#37;&#44; respectively&#44; after treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A lack of knowledge of this condition can result in the incorrect diagnosis of IVGG recipients with latent infections&#44; leading to stress and unnecessary treatment<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;e&#46;g&#46; in patients who will subsequently be treated with rituximab for autoimmune blistering diseases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Another infection that can cause confusion is syphilis&#44; since IVGG infusions can contain antibodies that are identified in treponemal tests&#44; although reagin tests are always negative&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a> Cases have been described in which patients treated with IVGG have tested positive for<span class="elsevierStyleItalic">Toxoplasma</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and <span class="elsevierStyleItalic">Borrelia burgdoferi</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Positivity for pathogens against which the population is frequently immunized&#44; including varicella-zoster virus and parvovirus B19&#44; can also be expected after IVGG therapy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; in patients treated with IVGG&#44; positive microbiological serology results should be interpreted with caution&#46; For some pathogens&#44; such as <span class="elsevierStyleItalic">T pallidum</span>&#44; <span class="elsevierStyleItalic">B burgdorferi</span>&#44; and <span class="elsevierStyleItalic">Toxoplasma</span>&#44; serology should be repeated 4 to 8 weeks later &#40;the half-life of IgG is 3 weeks&#41; and again until values return to normal&#46; If available&#44; molecular diagnostic techniques &#40;e&#46;g&#46; HBV DNA detection&#41; should be requested&#44; as these can more quickly rule out an active infection&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Furthermore&#44; if IVGG is used to treat diseases that may subsequently require the use of biological drugs such as rituximab&#44; it may be advisable to have baseline serology data at hand&#44; as this will facilitate interpretation of the results of pretreatment screening studies after IVGG infusion&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; S&#225;nchez-Herrero A&#44; Nieto-Benito LM&#44; Rosell-D&#237;az AM&#44; Pulido-P&#233;rez A&#46; Falsa positividad serol&#243;gica para la hepatitis B tras el empleo de inmunoglobulinas intravenosas para una necr&#243;lisis epid&#233;rmica t&#243;xica&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;476&#8211;477&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Ab&#44; antibody&#59; Ag&#44; antigen&#59; CT&#44; computed tomography&#59; CSF&#44; cerebrospinal fluid&#59; EIA&#44; enzyme immunoassay&#59; FTA Abs&#44; fluorescent treponemal antibody absorption test&#59; GM&#44; galactomannan&#59; HBcAb&#44; hepatitis B core antibody&#59; HBsAb&#44; hepatitis B surface antibody&#59; IgG&#44; immunoglobulin G&#59; IVGG&#44; human intravenous gamma globulin&#59; PCR&#44; polymerase chain reaction&#59; RPR&#44; fast plasma reagin&#59; TPHA&#44; <span class="elsevierStyleItalic">Treponema pallidum</span> hemagglutination assay&#59; VDRL&#44; Venereal Disease Research Laboratory test&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serological Results&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microbiological Diagnosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic Approach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">Hepatitis B virus<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;7</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAb positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous hepatitis B infection</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Request PCR for viral DNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBcAb &#40;IgG&#41; positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Repeat blood tests in 6&#8211;8 weeks</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Syphilis &#40;<span class="elsevierStyleItalic">T pallidum</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive treponemal tests &#40;EIA&#8239;&#177;&#8239;TPHA&#47;FTA Abs&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treated syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repeat blood tests after several weeks&#46; There are no tests for direct diagnosis</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Negative RPR and VDRL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Late latent syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">B burgdorferi</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA positive for <span class="elsevierStyleItalic">Borrelia</span> IgG</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borreliosis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR for <span class="elsevierStyleItalic">Borrelia</span> in blood or CSF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repeat blood tests after several weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive aspergillosis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA positive for GM</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive <span class="elsevierStyleItalic">Aspergillus</span> infection in neutropenic patients with hematological fever</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR for <span class="elsevierStyleItalic">Aspergillus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EIA for GM &#40;bronchioalveolar lavage&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thoracic CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Positive Serological Results Reported in Intravenous Gamma Globulin Recipients&#44; Microbiological Diagnosis That Patients Would Have Received if not Exposed to Gamma Globulins&#44; and Approach Taken to Verify a False-positive Caused by Passive Antibody Transfusion</p>"
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                    0 => array:2 [
                      "titulo" => "Dermatology and immunoglobulin therapy&#58; who to treat and how to administer immunoglobulins"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;J&#46; Navarro-Trivi&#241;o"
                            1 => "I&#46; P&#233;rez-L&#243;pez"
                            2 => "R&#46; Ruiz-Villaverde"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2017.11.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2018"
                        "volumen" => "109"
                        "paginaInicial" => "323"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29429551"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
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                            1 => "M&#46;S&#46; Kruskall"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1537-2995.2003.00519.x"
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                    0 => array:2 [
                      "titulo" => "Immunoglobulin therapy and passive transfer of anti-HBc&#58; too often forgotten"
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                    0 => array:2 [
                      "doi" => "10.1016/S2352-3026(18)30158-3"
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                      "titulo" => "Transmission of hepatitis B core antibody and galactomannan enzyme immunoassay positivity via immunoglobulin products&#58; a comprehensive analysis"
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                            3 => "S&#46; Workman"
                            4 => "A&#46; Symes"
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                      "doi" => "10.1093/cid/ciw222"
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                      "titulo" => "An unusual case of anti-<span class="elsevierStyleItalic">Borrelia burgdorferi</span> immunoglobulin G seroconversion caused by administration of intravenous gammaglobulins"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">The authors thank the allergology service&#44; and especially Pilar Tornero for her tireless work with patients with allergic skin reactions&#46; Thanks also to the hospital&#8217;s intensive care service for their assistance in the management of this case&#46;</p>"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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