Case report
Early Interstitial Lung Disease in Microscopic Polyangiitis: Case Report and Literature Review
Enfermedad pulmonar intersticial temprana en poliangeitis microscópica: reporte de un caso y revisión de la literatura
Read
5247
Timeswas read the article
2052
Total PDF
3195
Total HTML
Share statistics
array:24 [ "pii" => "S2173574317301545" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.10.006" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "978" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2018;14:106-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 142 "formatos" => array:3 [ "EPUB" => 30 "HTML" => 25 "PDF" => 87 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X16301322" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2016.10.003" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "978" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2018;14:106-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2960 "formatos" => array:3 [ "EPUB" => 176 "HTML" => 1721 "PDF" => 1063 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Enfermedad pulmonar intersticial temprana en poliangitis microscópica: reporte de un caso y revisión de la literatura" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Early interstitial lung disease in microscopic polyangiitis: Case report and literature review" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "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" => 677 "Ancho" => 950 "Tamanyo" => 154951 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudio histopatológico de biopsia del pulmón, con vasculitis de vasos pequeños, con extensas áreas de fibrosis y enfisema pulmonar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcos García-Nava, Heidegger Mateos-Toledo, Ana Patricia Georgina Guevara-Canseco, Cesar Eduardo Infante-González, Diego Alberto Reyes-Nava, Emilio Estrada-Castro" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Marcos" "apellidos" => "García-Nava" ] 1 => array:2 [ "nombre" => "Heidegger" "apellidos" => "Mateos-Toledo" ] 2 => array:2 [ "nombre" => "Ana Patricia Georgina" "apellidos" => "Guevara-Canseco" ] 3 => array:2 [ "nombre" => "Cesar Eduardo" "apellidos" => "Infante-González" ] 4 => array:2 [ "nombre" => "Diego Alberto" "apellidos" => "Reyes-Nava" ] 5 => array:2 [ "nombre" => "Emilio" "apellidos" => "Estrada-Castro" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574317301545" "doi" => "10.1016/j.reumae.2016.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317301545?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301322?idApp=UINPBA00004M" "url" => "/1699258X/0000001400000002/v1_201803080430/S1699258X16301322/v1_201803080430/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574317301533" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.09.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "976" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2018;14:109-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 141 "formatos" => array:3 [ "EPUB" => 28 "HTML" => 32 "PDF" => 81 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "SAPHO Syndrome in Childhood. A Case Report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "109" "paginaFinal" => "112" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome SAPHO en la infancia. Presentación de un caso clínico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1557 "Ancho" => 1268 "Tamanyo" => 90511 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy showing several areas of uptake (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Vargas Pérez, Belén Sevilla Pérez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Vargas Pérez" ] 1 => array:2 [ "nombre" => "Belén" "apellidos" => "Sevilla Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16301309" "doi" => "10.1016/j.reuma.2016.09.007" "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/S1699258X16301309?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317301533?idApp=UINPBA00004M" "url" => "/21735743/0000001400000002/v1_201803210429/S2173574317301533/v1_201803210429/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574318300236" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.01.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1007" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Reumatol Clin. 2018;14:97-105" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 20 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 9 "PDF" => 7 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Tropical Arthritogenic Alphaviruses" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "105" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alfavirus tropicales artritogénicos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 2505 "Ancho" => 3307 "Tamanyo" => 562300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Risk of transmission and establishment of <span class="elsevierStyleItalic">Aedes albopictus</span> (tiger mosquito) in temperate zones of southern Europe. Illustration obtained from the European Centre for Disease Prevention and Control (ECDC).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carla-Ruth Mejía, Rogelio López-Vélez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carla-Ruth" "apellidos" => "Mejía" ] 1 => array:2 [ "nombre" => "Rogelio" "apellidos" => "López-Vélez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17300256" "doi" => "10.1016/j.reuma.2017.01.006" "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/S1699258X17300256?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300236?idApp=UINPBA00004M" "url" => "/21735743/0000001400000002/v1_201803210429/S2173574318300236/v1_201803210429/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Early Interstitial Lung Disease in Microscopic Polyangiitis: Case Report and Literature Review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "108" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marcos García-Nava, Heidegger Mateos-Toledo, Ana Patricia Georgina Guevara-Canseco, Cesar Eduardo Infante-González, Diego Alberto Reyes-Nava, Emilio Estrada-Castro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Marcos" "apellidos" => "García-Nava" "email" => array:1 [ 0 => "mark_g_n@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" => "Heidegger" "apellidos" => "Mateos-Toledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana Patricia Georgina" "apellidos" => "Guevara-Canseco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Cesar Eduardo" "apellidos" => "Infante-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Diego Alberto" "apellidos" => "Reyes-Nava" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Emilio" "apellidos" => "Estrada-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Centro Médico ISSEMyM Toluca, Metepec, Estado de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica de enfermedades intersticiales del pulmón, Instituto Nacional de Enfermedades Respiratorias, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad pulmonar intersticial temprana en poliangeitis microscópica: reporte de un caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 677 "Ancho" => 950 "Tamanyo" => 155283 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histopathological study of the lung specimen demonstrates small-vessel vasculitis with extensive areas of fibrosis and pulmonary emphysema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 56-year-old man, an ex-smoker of 4 cigarettes/day. One month prior to being admitted to the hospital, his health status was characterized by a condition of general deterioration. He had a nonproductive cough, fever of up to 39<span class="elsevierStyleHsp" style=""></span>°C – predominantly in the evening, arthralgia in elbows, knees and carpi, and right-sided chest pleuritic pain. Physical examination revealed bilateral subscapular fine crackles and proximal muscle weakness in all 4 limbs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Laboratory tests showed that he had normocytic normochromic anemia. Rheumatoid factor was 65.3<span class="elsevierStyleHsp" style=""></span>IU/L, C-reactive protein 290.4<span class="elsevierStyleHsp" style=""></span>mg/L, total creatine kinase 3.6<span class="elsevierStyleHsp" style=""></span>U/L, creatinine 2.8<span class="elsevierStyleHsp" style=""></span>mg/dL, urea 86.5<span class="elsevierStyleHsp" style=""></span>mg/dL and blood urea nitrogen 40<span class="elsevierStyleHsp" style=""></span>mg/dL. In urine, we observed proteinuria with a level of 75<span class="elsevierStyleHsp" style=""></span>mg/dL and erythrocytes at 260<span class="elsevierStyleHsp" style=""></span>cells/mL, with active sediment characterized by dysmorphic erythrocytes. No evidence of bacteria in urine culture, blood culture, sputum culture or stool culture. The results of a viral panel for hepatitis C virus, hepatitis B virus and human immunodeficiency virus were negative. High-resolution computed tomography of the chest revealed interstitial involvement with a pattern of irregular septal thickening and areas of alveolar filling with air bronchogram in peripherally distributed patches (pattern of organizing pneumonia) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). An electromyographic study showed a pattern indicating a demyelinating disease. Bronchoalveolar lavage demonstrated nonspecific chronic and acute inflammation. Studies focusing on autoimmunity found the patient to be positive for antinuclear antibodies at a titer of 1:320 with a mitochondrial pattern, as well as for perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). The specificity of anti-myeloperoxidase antibodies (anti-MPO) was positive; whereas that of other autoantibodies (anti-Jo-1, anti-Scl-70, anti-double-stranded DNA and anti-cyclic citrullinated peptide antibodies) was negative. The histopathological study of the lung specimen demonstrated small-vessel vasculitis with extensive areas of fibrosis and pulmonary emphysema (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The presence of interstitial lung disease (ILD), ANCA-associated vasculitis (AAV), proteinuria and neuropathy enabled the classification of the disorder as microscopic polyangiitis (MPA). The treatment was based on pulses of methylprednisolone, azathioprine and rituximab. The outcome was satisfactory, with improvement of the symptoms and signs 4 weeks after treatment, and the absence of relapse over a 3-month period of observation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">In this case of MPA, the presence of early ILD results in an uncommon pattern in lung disease, rather than capillaritis with alveolar hemorrhage and the usual interstitial pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> In ILD, the main pathological finding lies in the interstitial alveolar structure; however, the airways and pulmonary vasculature can also be affected.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The association of MPA and AAV was described by Arulkumaran et al. in 510 patients, in 14 (2.7%) of whom it was associated with ILD; all of them were positive for p-ANCA and MPO and were diagnosed with MPA.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Eschun et al. reported similar findings in 6 patients in which the initial manifestation was ILD, which was followed by the development of vasculitis documented by positive p-ANCA and renal biopsy. The histopathological study usually demonstrates rapidly progressive and/or necrotizing crescentic glomerulonephritis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The mechanisms of lung injury in ILD with AAV are not fully understood. However, repeated episodes of subclinical alveolar hemorrhage and/or the effects of autoantibodies on the surface of neutrophils could induce proinflammatory cytokine production and the release of free radicals resulting in alveolar epithelial injury and pulmonary fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are no guidelines for the treatment of patients with MPA and ILD. At the present time, they are managed along the lines of small-vessel vasculitis. The prognosis of this association is uncertain, and no significant differences are observed with respect to mortality.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, the association of ILD and MPA is not very common. However, clinicians in their diagnostic approach to ILD must take into account the possibility of underlying AAV.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical Disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0050" 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="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0055" 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="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1006155" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec965911" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1006154" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec965912" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-15" "fechaAceptado" => "2016-10-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec965911" "palabras" => array:3 [ 0 => "Microscopic polyangiitis" 1 => "Interstitial lung disease" 2 => "Organizing pneumonia pattern" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec965912" "palabras" => array:3 [ 0 => "Poliangeítis microscópica" 1 => "Enfermedad pulmonar intersticial" 2 => "Patrón de neumonía organizada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic polyangiitis (MPA) is a systemic disease included in the Chapel Hill 2012 Classification as necrotizing vasculitis affecting capillaries, venules and arterioles. It usually expresses antineutrophil cytoplasmic antibodies (ANCA) and has a perinuclear immunofluorescence pattern and correlation with anti-myeloperoxidase (MPO) antibodies. Capillaritis with alveolar hemorrhage is the most common manifestation of lung disease. Interstitial lung disease (ILD) is uncommon, with usual interstitial pneumonia being the predominant pattern. However, other patterns such as organizing pneumonia have been described. No guidelines exist for treating patients with ILD and, currently, ANCA-associated vasculitis (AAV) is managed along the lines of small vessel vasculitis. The prognosis with this association is uncertain, with possibilities of relapse and a fatal outcome. We present a case in which ILD was the first manifestation of MPA, without alveolar hemorrhage, with subsequent renal involvement and, in which, the established treatment produced a significant clinical improvement.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La poliangeítis microscópica (PAM) es una enfermedad sistémica incluida en la clasificación de Chapel Hill 2012 como vasculitis necrosante que afecta capilares, vénulas y arteriolas. Usualmente expresa anticuerpos anti-citoplasma de neutrófilo (ANCA), con patrón perinuclear en la inmunofluorescencia, y correlación con los anticuerpos anti-mieloperoxidasa (MPO). La capilaritis con hemorragia alveolar es la manifestación más usual de afección pulmonar. La enfermedad pulmonar intersticial (EPI) es infrecuente, siendo la neumonía intersticial común el patrón predominante, sin embargo, otros patrones como la neumonía organizada han sido descritos. No existen pautas de tratamiento de los pacientes con EPI y vasculitis asociada a ANCA (VAA); actualmente son tratados con las bases de las vasculitis de vasos pequeños. El pronóstico de esta asociación es incierto, con posibilidad de recaídas y de curso fatal. A continuación se presenta un caso en el que neumopatía intersticial fue la primera manifestación de una PAM, sin hemorragia alveolar, con posterior involucro renal, y con el tratamiento instaurado presenta mejoría clínica significativa.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Nava M, Mateos-Toledo H, Guevara-Canseco APG, Infante-González CE, Reyes-Nava DA, Estrada-Castro E. Enfermedad pulmonar intersticial temprana en poliangeitis microscópica: reporte de un caso y revisión de la literatura. Reumatol Clin. 2018;14:106-108.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1497 "Ancho" => 1600 "Tamanyo" => 284457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">High-resolution computed tomography of the chest, showing interstitial involvement with a pattern of irregular septal thickening and areas of alveolar filling with air bronchogram in peripherally distributed patches (pattern of organizing pneumonia).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 677 "Ancho" => 950 "Tamanyo" => 155283 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histopathological study of the lung specimen demonstrates small-vessel vasculitis with extensive areas of fibrosis and pulmonary emphysema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of ANCA associated vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Berden" 1 => "A. Göçeroglu" 2 => "D. Jayne" 3 => "R. Luqmani" 4 => "N. Rasmussen" 5 => "J.A. Bruijn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "344" "paginaInicial" => "e26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22250224" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Key advances in the clinical approach to ANCA-associated vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.G. Kallenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrrheum.2014.104" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Rheumatol" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "484" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24980139" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y tratamiento de las enfermedades pulmonares intersticiales difusas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Xaubet" 1 => "R. Ancochea" 2 => "C. Blanquer" 3 => "F. Montero" 4 => "E. Morell" 5 => "B. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2003" "volumen" => "39" "paginaInicial" => "580" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14636495" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patrones radiológicos en la enfermedad pulmonar intersticial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Jiménez Palleiro" 1 => "T. Franquet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semin Fund Esp Reumatol" "fecha" => "2003" "volumen" => "14" "paginaInicial" => "97" "paginaFinal" => "105" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary manifestations of granulomatosis with polyangiitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gómez-Gómez" 1 => "M.U. Martínez-Martínez" 2 => "E. Cuevas-Orta" 3 => "J.M. Bernal-Blanco" 4 => "D. Cervantes-Ramírez" 5 => "R. Martínez-Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2013.12.010" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "288" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24529938" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial lung disease and ANCA-associated vasculitis: a retrospective observational cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Arulkumaran" 1 => "N. Periselneris" 2 => "G. Gaskin" 3 => "N. Strickland" 4 => "P.W. Ind" 5 => "C.D. Pusey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2011" "volumen" => "50" "paginaInicial" => "2035" "paginaFinal" => "2043" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ANCA-associated lung fibrosis: analysis of 17 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Foulon" 1 => "P. Delaval" 2 => "D. Valeyre" 3 => "B. Wallaert" 4 => "M.P. Debray" 5 => "M. Brauner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2008.04.023" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2008" "volumen" => "102" "paginaInicial" => "1392" "paginaFinal" => "1398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18640019" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary interstitial fibrosis as a presenting manifestation in perinuclear antineutrophilic cytoplasmic antibody microscopic polyangiitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Eschun" 1 => "S. Mink" 2 => "S. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2003" "volumen" => "123" "paginaInicial" => "297" "paginaFinal" => "301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12527637" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial lung disease with ANCA-associated vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Katsumata" 1 => "Y. Kawaguchi" 2 => "H. Yamanaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4137/CCRPM.S23314" "Revista" => array:7 [ "tituloSerie" => "Clin Med Insights Circ Respir Pulm Med" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "51" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26448696" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1064748114003455" "estado" => "S300" "issn" => "10647481" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-neutrophil cytoplasmic autoantibodies induce neutrophils to degranulate and produce oxygen radicals in vitro" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.J. Falk" 1 => "R.S. Terrell" 2 => "L.A. Charles" 3 => "J.C. Jennette" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Proc Natl Acad Sci USA" "fecha" => "1990" "volumen" => "87" "paginaInicial" => "4115" "paginaFinal" => "4119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2161532" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001400000002/v1_201803210429/S2173574317301545/v1_201803210429/en/main.assets" "Apartado" => array:4 [ "identificador" => "43296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001400000002/v1_201803210429/S2173574317301545/v1_201803210429/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317301545?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 72 | 36 | 108 |
| 2024 September | 83 | 13 | 96 |
| 2024 August | 100 | 34 | 134 |
| 2024 July | 78 | 38 | 116 |
| 2024 June | 81 | 26 | 107 |
| 2024 May | 103 | 26 | 129 |
| 2024 April | 97 | 24 | 121 |
| 2024 March | 69 | 30 | 99 |
| 2024 February | 63 | 25 | 88 |
| 2024 January | 65 | 20 | 85 |
| 2023 December | 58 | 40 | 98 |
| 2023 November | 59 | 41 | 100 |
| 2023 October | 51 | 38 | 89 |
| 2023 September | 70 | 40 | 110 |
| 2023 August | 47 | 10 | 57 |
| 2023 July | 64 | 30 | 94 |
| 2023 June | 47 | 18 | 65 |
| 2023 May | 56 | 24 | 80 |
| 2023 April | 45 | 14 | 59 |
| 2023 March | 47 | 32 | 79 |
| 2023 February | 61 | 28 | 89 |
| 2023 January | 47 | 33 | 80 |
| 2022 December | 71 | 30 | 101 |
| 2022 November | 51 | 35 | 86 |
| 2022 October | 61 | 28 | 89 |
| 2022 September | 47 | 37 | 84 |
| 2022 August | 48 | 46 | 94 |
| 2022 July | 49 | 44 | 93 |
| 2022 June | 30 | 24 | 54 |
| 2022 May | 38 | 40 | 78 |
| 2022 April | 46 | 50 | 96 |
| 2022 March | 42 | 64 | 106 |
| 2022 February | 46 | 31 | 77 |
| 2022 January | 64 | 33 | 97 |
| 2021 December | 37 | 42 | 79 |
| 2021 November | 45 | 55 | 100 |
| 2021 October | 50 | 69 | 119 |
| 2021 September | 50 | 40 | 90 |
| 2021 August | 36 | 48 | 84 |
| 2021 July | 34 | 48 | 82 |
| 2021 June | 57 | 43 | 100 |
| 2021 May | 47 | 69 | 116 |
| 2021 April | 116 | 130 | 246 |
| 2021 March | 83 | 40 | 123 |
| 2021 February | 56 | 29 | 85 |
| 2021 January | 39 | 32 | 71 |
| 2020 December | 64 | 29 | 93 |
| 2020 November | 55 | 29 | 84 |
| 2020 October | 36 | 24 | 60 |
| 2020 September | 56 | 38 | 94 |
| 2020 August | 61 | 20 | 81 |
| 2020 July | 58 | 33 | 91 |
| 2020 June | 42 | 15 | 57 |
| 2020 May | 30 | 19 | 49 |
| 2020 April | 36 | 17 | 53 |
| 2020 March | 22 | 12 | 34 |
| 2020 February | 1 | 0 | 1 |
| 2018 October | 0 | 1 | 1 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 0 | 1 | 1 |
| 2018 March | 15 | 20 | 35 |
| 2018 February | 3 | 35 | 38 |
| 2018 January | 6 | 26 | 32 |
| 2017 December | 0 | 3 | 3 |
Show all
