Images in Clinical Rheumatology
Cutaneous Manifestations in Antiphospholipid Syndrome
Manifestaciones cutáneas del síndrome antifosfolípido
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In the carotid territory, only the common carotid artery is affected, there being no extension to internal carotid artery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. del Pilar García-Cezón de la Cruz, Raquel Almodóvar, Javier García Pérez, Patricia Fanny Dhimes, Pedro Zarco" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M. del Pilar" "apellidos" => "García-Cezón de la Cruz" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Almodóvar" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "García Pérez" ] 3 => array:2 [ "nombre" => "Patricia Fanny" "apellidos" => "Dhimes" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "Zarco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16300109" "doi" => "10.1016/j.reuma.2016.03.016" "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/S1699258X16300109?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300345?idApp=UINPBA00004M" "url" => "/21735743/0000001300000004/v1_201707050008/S2173574317300345/v1_201707050008/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Cutaneous Manifestations in Antiphospholipid Syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "233" "paginaFinal" => "234" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucía Campos-Muñoz, Alejandro Fueyo-Casado, Jose Antonio Cortés-Toro, Eduardo López-Bran" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Lucía" "apellidos" => "Campos-Muñoz" "email" => array:1 [ 0 => "luciacampos78@hotmail.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" => "Alejandro" "apellidos" => "Fueyo-Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jose Antonio" "apellidos" => "Cortés-Toro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Eduardo" "apellidos" => "López-Bran" "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 Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manifestaciones cutáneas del síndrome antifosfolípido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2459 "Ancho" => 2833 "Tamanyo" => 1219443 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Livedo reticularis in its variant, livedo racemose, involving both lower limbs in their entirety. (b) Purpuric discoloration on the second toe. (c) Skin displayed epidermal necrosis and the presence of hyaline thrombi in the papillary dermal vessels (hematoxylin–eosin, 100×). (d) Greater detail of the thrombi (hematoxylin–eosin, 20×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 54-year-old woman who had no significant previous medical history. She presented with pruriginous lesions that had started on her legs 1 year earlier and had spread to her thighs, buttocks and upper limbs. They were accompanied by slight fever and arthralgia. Physical examination revealed an irregular and diffuse violaceous reticulated discoloration that in certain regions had become purpuric. They were very suggestive of livedo reticularis or livedo racemosa (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). She also had distal purpura on the second toe of her right foot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The differential diagnosis included cryoglobulinemia, polyarteritis nodosa, livedoid vasculopathy, cholesterol crystal embolism concomitant with arteriosclerosis, polycythemia vera, essential thrombocytopenia, atrial myxoma, etc. Skin biopsy revealed hyaline thrombi in the papillary dermal vessels, with no inflammatory infiltrate in the vascular wall (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c, d). An antibody positive for lupus anticoagulant was detected, and was confirmed 12 weeks later. She was treated with acetylsalicylic acid, chloroquine and prednisone, which led to the disappearance of the systemic clinical manifestations, complete resolution of the distal purpura and attenuation of the livedo racemosa, which became less evident.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Antiphospholipid syndrome (APS) is a prothrombotic state characterized by the presence of antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant or anti-β<span class="elsevierStyleInf">2</span>-glycoprotein I). The diagnosis also requires evidence of arterial, venous or microcirculation thrombosis or a history of recurrent fetal loss.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1–3</span></a> It is also frequently accompanied by cutaneous manifestations (which occur in up to 40%–50% of the patients). Livedo reticularis is the disorder most widely reported and, on occasion, they may be the first sign of the disease.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> Other possible lesions are skin ulcers, purpuric lesions, skin necrosis, superficial thrombophlebitis and atrophie blanche-type lesions.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a> Our familiarity with these manifestations would enable us to make a diagnosis as early as possible and prevent potential complications of the disease.</p><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="par0030" 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="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 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:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-05" "fechaAceptado" => "2016-03-31" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Campos-Muñoz L, Fueyo-Casado A, Cortés-Toro JA, López-Bran E. Manifestaciones cutáneas del síndrome antifosfolípido. Reumatol Clin. 2017;13:233–234.</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" => 2459 "Ancho" => 2833 "Tamanyo" => 1219443 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Livedo reticularis in its variant, livedo racemose, involving both lower limbs in their entirety. (b) Purpuric discoloration on the second toe. (c) Skin displayed epidermal necrosis and the presence of hyaline thrombi in the papillary dermal vessels (hematoxylin–eosin, 100×). (d) Greater detail of the thrombi (hematoxylin–eosin, 20×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relevance of non-criteria clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Abreu" 1 => "A. Darowski" 2 => "D. Wahh" 3 => "M.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 14 | 28 |
| 2024 October | 78 | 45 | 123 |
| 2024 September | 89 | 21 | 110 |
| 2024 August | 82 | 36 | 118 |
| 2024 July | 59 | 22 | 81 |
| 2024 June | 76 | 40 | 116 |
| 2024 May | 93 | 42 | 135 |
| 2024 April | 89 | 25 | 114 |
| 2024 March | 116 | 29 | 145 |
| 2024 February | 76 | 29 | 105 |
| 2024 January | 104 | 27 | 131 |
| 2023 December | 64 | 25 | 89 |
| 2023 November | 58 | 26 | 84 |
| 2023 October | 78 | 40 | 118 |
| 2023 September | 83 | 36 | 119 |
| 2023 August | 61 | 11 | 72 |
| 2023 July | 90 | 32 | 122 |
| 2023 June | 70 | 23 | 93 |
| 2023 May | 93 | 28 | 121 |
| 2023 April | 62 | 4 | 66 |
| 2023 March | 86 | 41 | 127 |
| 2023 February | 74 | 34 | 108 |
| 2023 January | 81 | 15 | 96 |
| 2022 December | 67 | 35 | 102 |
| 2022 November | 88 | 29 | 117 |
| 2022 October | 84 | 26 | 110 |
| 2022 September | 80 | 45 | 125 |
| 2022 August | 60 | 52 | 112 |
| 2022 July | 67 | 35 | 102 |
| 2022 June | 69 | 28 | 97 |
| 2022 May | 74 | 45 | 119 |
| 2022 April | 88 | 43 | 131 |
| 2022 March | 89 | 61 | 150 |
| 2022 February | 97 | 49 | 146 |
| 2022 January | 94 | 66 | 160 |
| 2021 December | 61 | 46 | 107 |
| 2021 November | 63 | 52 | 115 |
| 2021 October | 86 | 55 | 141 |
| 2021 September | 82 | 47 | 129 |
| 2021 August | 39 | 48 | 87 |
| 2021 July | 53 | 26 | 79 |
| 2021 June | 73 | 29 | 102 |
| 2021 May | 80 | 53 | 133 |
| 2021 April | 182 | 109 | 291 |
| 2021 March | 138 | 32 | 170 |
| 2021 February | 64 | 22 | 86 |
| 2021 January | 76 | 21 | 97 |
| 2020 December | 90 | 31 | 121 |
| 2020 November | 66 | 29 | 95 |
| 2020 October | 43 | 13 | 56 |
| 2020 September | 38 | 22 | 60 |
| 2020 August | 43 | 23 | 66 |
| 2020 July | 26 | 31 | 57 |
| 2020 June | 32 | 25 | 57 |
| 2020 May | 27 | 17 | 44 |
| 2020 April | 20 | 15 | 35 |
| 2020 March | 16 | 8 | 24 |
| 2020 February | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 3 | 2 | 5 |
| 2018 April | 47 | 11 | 58 |
| 2018 March | 102 | 8 | 110 |
| 2018 February | 38 | 5 | 43 |
| 2018 January | 27 | 5 | 32 |
| 2017 December | 34 | 12 | 46 |
| 2017 November | 32 | 8 | 40 |
| 2017 October | 32 | 9 | 41 |
| 2017 September | 30 | 10 | 40 |
| 2017 August | 51 | 27 | 78 |
| 2017 July | 53 | 34 | 87 |
| 2017 June | 9 | 14 | 23 |
| 2017 May | 9 | 9 | 18 |
| 2017 April | 5 | 15 | 20 |
| 2017 March | 2 | 2 | 4 |
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