Images in Clinical Rheumatology
Haemophagocytic Syndrome in a Rheumatic Polymyalgia Patient
Síndrome hemofagocítico en paciente con polimialgia reumática
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=> "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1305 "Tamanyo" => 142096 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enlarged view of the histiocyte with vacuolated cytoplasm phagocytosing a hematopoietic cell.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was an 83-year-old man who was admitted to our department with hyperglycemia, but his reason for coming was that he felt generally unwell. He had type 2 diabetes and alcoholic cirrhosis with grade 2 esophageal varices, with no episodes of ascites-related decompensation, and had been diagnosed with polymyalgia rheumatica 6 months earlier; he reported having had symptoms consistent with upper respiratory infection the week before admission. Chest X-ray revealed an increase in the alveolar interstitial region, with no clear evidence of infiltrates. The most notable laboratory finding was pancytopenia, with a platelet count of 27<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>l. Tomography disclosed the presence of bilateral pleural effusion with posterior infiltrates and, in abdomen, an image consistent with hemoperitoneum, with spontaneous rupture of the spleen. On the basis of these findings, anemia was suspected. Analyses revealed a hemoglobin level of 8.5<span class="elsevierStyleHsp" style=""></span>mg/dL, ferritin level of 1102<span class="elsevierStyleHsp" style=""></span>ng/mL, erythrocyte sedimentation rate of 75<span class="elsevierStyleHsp" style=""></span>mm/first hour and hypertriglyceridemia (270<span class="elsevierStyleHsp" style=""></span>mg/dL). Bone marrow aspiration was performed and the bone marrow smear was studied using Wright's stain. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a histiocyte with vacuolated cytoplasm (arrow 1), phagocytosing a hematopoietic cell (arrow 2–lymphocyte). A histiocyte can also be seen phagocytosing a number of hematopoietic cells, with cellular debris in its cytoplasm. The findings obtained pointed to a diagnosis of haemophagocytic syndrome<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> and treatment with intravenous gammaglobulins was begun. The patient's clinical response was good, with an improved platelet count at the end of the treatment (85<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>l).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:2 [ "identificador" => "xack201747" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-09" "fechaAceptado" => "2015-03-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hurtado García R, Beneit Villena P, Martín Guillén S, Pérez Bernabéu A. Síndrome hemofagocítico en paciente con polimialgia reumática. Reumatol Clin. 2016;12:50–51.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1305 "Tamanyo" => 142096 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enlarged view of the histiocyte with vacuolated cytoplasm phagocytosing a hematopoietic cell.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult haemophagocytic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Ramos-Casals" 1 => "P. Brito-Zeron" 2 => "A. Lopez-Guillermo" 3 => "M.A. Khamashta" 4 => "X. Bosch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(13)61048-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "paginaInicial" => "1503" "paginaFinal" => "1610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24290661" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features of haemophagocytic síndrome in patients with systemic autoinmune diseases: analysis of 30 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Fukaya" 1 => "S. Yasyda" 2 => "T. Hashimoto" 3 => "K. Oku" 4 => "H. Kataoka" 5 => "T. Horita" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1686" "paginaFinal" => "1691" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack201747" "titulo" => "Acknowledgements" "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">We thank Dr. Pilar Brito-Zerón, of the Department of Autoimmune Diseases of the Hospital Clínic, without whose help, this case would not have had such a good ending.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000001/v1_201601240019/S2173574315001276/v1_201601240019/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000001/v1_201601240019/S2173574315001276/v1_201601240019/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315001276?idApp=UINPBA00004M" ]
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| 2016 October | 52 | 9 | 61 |
| 2016 September | 40 | 4 | 44 |
| 2016 August | 32 | 8 | 40 |
| 2016 July | 19 | 9 | 28 |
| 2016 February | 2 | 31 | 33 |
| 2016 January | 2 | 27 | 29 |
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