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Edema and Dermatomyositis. Migratory Edema and Edematous and Vesiculobullous Dermatomyositis Overlap
Edema y dermatomiositis. Edema migratorio y solapamiento de dermatomiositis edematosa y vesiculoampollosa
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Edema migratorio y solapamiento de dermatomiositis edematosa y vesiculoampollosa" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Edema and dermatomyositis. Migratory edema and edematous and vesiculobullous dermatomyositis overlap" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 900 "Ancho" => 1200 "Tamanyo" => 117913 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a: Placa eritematoedematosa con vesiculoampollas en superficie en miembro superior derecho. b. Edema y placas eritematoedematosas en los muslos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Belén Lozano-Masdemont, Ana Pulido-Pérez, Verónica Parra-Blanco, José Antonio Avilés-Izquierdo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Belén" "apellidos" => "Lozano-Masdemont" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Pulido-Pérez" ] 2 => array:2 [ "nombre" => "Verónica" "apellidos" => "Parra-Blanco" ] 3 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Avilés-Izquierdo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574318301059" "doi" => "10.1016/j.reumae.2017.09.003" "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/S2173574318301059?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302413?idApp=UINPBA00004M" "url" => "/1699258X/0000001400000005/v1_201809090415/S1699258X17302413/v1_201809090415/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173574318300923" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.08.003" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1116" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2018;14:314-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Rice Bodies in Tuberculous Tenosynovitis of Wrist" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "316" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuerpos de arroz en la tenosinovitis tuberculosa de la muñeca" ] ] "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" => 977 "Ancho" => 1405 "Tamanyo" => 108770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) T2W FAT SAT sagittal image show a well defined fluid intensity collection seen along the flexor tendon sheath with presence of hypointense layered rice grain (white arrow) shaped within it suggestive of tenosynovitis with multiple loose bodies. (B) T2W Coronal images show well defined fluid intensity collection anterior to the wrist joint along the flexor tendon sheath suggestive of tenosynovitis. 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Migratory Edema and Edematous and Vesiculobullous Dermatomyositis Overlap" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Belén Lozano-Masdemont, Ana Pulido-Pérez, Verónica Parra-Blanco, José Antonio Avilés-Izquierdo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Belén" "apellidos" => "Lozano-Masdemont" "email" => array:1 [ 0 => "belenmasdemont@gmail.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" => "Ana" "apellidos" => "Pulido-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Verónica" "apellidos" => "Parra-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Avilés-Izquierdo" "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 General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, 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" => "Edema y dermatomiositis. Edema migratorio y solapamiento de dermatomiositis edematosa y vesiculoampollosa" ] ] "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" => 900 "Ancho" => 1200 "Tamanyo" => 117913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Erythematous and edematous plaque with superficial vasiculobullae in right upper limb. (b) Edema and erythematous and edematous plaques on thighs.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Extrafacial edema is a rare manifestation of dermatomyositis (DM). We report 2 cases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case no. 1. The patient was an 86-year-old woman who was admitted with dysphagia, dyspnea, weakness in her 4 extremities (2/5) and edemas. Four years earlier, she had been diagnosed with cryptogenic organizing pneumonia detected by means of pulmonary function tests, imaging studies and histology. It was observed that, aside from periorbital edema, she had edema with fovea in upper and lower limbs. She had plaques with vesiculobullous eruption on her forearms and erythematous and edematous eruption on her thighs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsy of the thigh revealed epidermal atrophy, subepidermal bullous disease, necrotic keratinocytes, superficial perivascular infiltrate, mucin and dermal edema. Direct immunofluorescence was negative, as were tests for anti-Jo-1, anti-PL7, anti-PL12, anti-SRP-54, anti-Mi2, anti-Ku and anti-PM/Scl antibodies. Creatine kinase (CK) was 1267<span class="elsevierStyleHsp" style=""></span>U/L. Electromyogram demonstrated the myopathic changes and muscle biopsy revealed perifascicular atrophy and CD4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>perimysium and perivascular inflammatory infiltrate.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A cardiac origin of the edema was ruled out, as were renal, hepatic and thyroid origin. Albumin, after multiple hospital admissions for dyspnea, weakness and edemas, had decreased (2.5–3.2<span class="elsevierStyleHsp" style=""></span>g/dL) and reached normality after treatment with corticosteroids. Having reviewed her history, we finally discovered the diagnosis of her lung disease: an elevated CK level (1370<span class="elsevierStyleHsp" style=""></span>U/L). Computed tomography revealed a breast lesion that was found to be an infiltrating ductal carcinoma. She was treated with prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg body weight (bw)/day and 5 sessions of plasmapheresis. After mastectomy, dysphagia persisted and we detected a diffuse disseminated signet ring cell adenocarcinoma. She died 4 months later due to respiratory failure.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case no. 2. The patient was a 71-year-old man who had been treated 7 months earlier for cancer of the cavum. He presented with weakness of his upper (2/5) and lower (3/5) limbs, skin lesions and migratory swelling: it began in his neck and supraclavicular region, followed by ankles, abdomen and upper limbs. Other causes of edema were ruled out. His CK level was 728<span class="elsevierStyleHsp" style=""></span>U/L and the same antibody panel was negative. Electromyogram and muscle biopsy were similar to those of case no. 1. A week with prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg bw/day, resolved the edema; treatment was increased with methotrexate at 20<span class="elsevierStyleHsp" style=""></span>mg/week, but he died 7 months later due to muscular respiratory failure.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Edematous DM<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a> could constitute up to 6% of the cases of DM.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is characterized by extrafacial, localized or generalized edema, with or without fovea, with no other cause of edema. It is more prevalent in women (2:1), of ages between 23 and 93 years. The diagnostic delay is more than 2 months.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is speculated that it is originated by ischemia of the microvasculature. To date, the migratory localization so characteristic of our case had not been reported. Vesiculobullous DM consists of subepidermal vesiculobullae with biopsy results typical of DM, with no other bullous dermatosis. Its cause has been proposed to be friction, dermal edema and mucin. The specimen for the biopsy in the first case was taken from the patient's thigh, where no clinical detachment was observed. We subsequently considered that the detachment was secondary to the edema and that the two clinical forms, edematous and vesiculobullous, could be the same manifestation or overlap. The distribution does not indicate a mechanical cause and there are similar cases of severe edema in which detachment appeared.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The cause of hypoalbuminemia of the first case was due to the proinflammatory status of the interstitial lung disease and the DM that still had not been diagnosed.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> This hypoalbuminemia could be the cause of generalized edema, but not of the erythematous and edematous and vesiculobullous plaques. The literature demonstrates that edematous DM could be associated with a more severe myopathy and dysphagia, a finding that was not observed in our patients.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Likewise, vesiculobullous DM would be closely associated with neoplasms and a worse prognosis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,10</span></a> Extrafacial edema in DM, in any of its variants should alert physicians to a greater severity and lead to an active search for a neoplasm.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano-Masdemont B, Pulido-Pérez A, Parra-Blanco V, Avilés-Izquierdo JA. Edema y dermatomiositis. Edema migratorio y solapamiento de dermatomiositis edematosa y vesiculoampollosa. Reumatol Clin. 2018;14:313–314.</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" => 900 "Ancho" => 1200 "Tamanyo" => 117913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Erythematous and edematous plaque with superficial vasiculobullae in right upper limb. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 93 | 39 | 132 |
| 2024 September | 103 | 20 | 123 |
| 2024 August | 104 | 40 | 144 |
| 2024 July | 125 | 39 | 164 |
| 2024 June | 110 | 40 | 150 |
| 2024 May | 94 | 41 | 135 |
| 2024 April | 107 | 33 | 140 |
| 2024 March | 127 | 48 | 175 |
| 2024 February | 79 | 29 | 108 |
| 2024 January | 100 | 24 | 124 |
| 2023 December | 84 | 29 | 113 |
| 2023 November | 82 | 27 | 109 |
| 2023 October | 117 | 29 | 146 |
| 2023 September | 176 | 45 | 221 |
| 2023 August | 122 | 20 | 142 |
| 2023 July | 136 | 26 | 162 |
| 2023 June | 109 | 29 | 138 |
| 2023 May | 107 | 27 | 134 |
| 2023 April | 88 | 9 | 97 |
| 2023 March | 111 | 27 | 138 |
| 2023 February | 110 | 32 | 142 |
| 2023 January | 107 | 23 | 130 |
| 2022 December | 105 | 31 | 136 |
| 2022 November | 125 | 21 | 146 |
| 2022 October | 119 | 52 | 171 |
| 2022 September | 160 | 30 | 190 |
| 2022 August | 120 | 42 | 162 |
| 2022 July | 97 | 44 | 141 |
| 2022 June | 125 | 38 | 163 |
| 2022 May | 151 | 59 | 210 |
| 2022 April | 115 | 61 | 176 |
| 2022 March | 135 | 57 | 192 |
| 2022 February | 135 | 31 | 166 |
| 2022 January | 157 | 54 | 211 |
| 2021 December | 119 | 45 | 164 |
| 2021 November | 102 | 31 | 133 |
| 2021 October | 107 | 51 | 158 |
| 2021 September | 96 | 48 | 144 |
| 2021 August | 67 | 35 | 102 |
| 2021 July | 76 | 43 | 119 |
| 2021 June | 79 | 38 | 117 |
| 2021 May | 104 | 41 | 145 |
| 2021 April | 193 | 128 | 321 |
| 2021 March | 92 | 33 | 125 |
| 2021 February | 89 | 24 | 113 |
| 2021 January | 159 | 27 | 186 |
| 2020 December | 97 | 22 | 119 |
| 2020 November | 79 | 15 | 94 |
| 2020 October | 72 | 19 | 91 |
| 2020 September | 98 | 30 | 128 |
| 2020 August | 80 | 21 | 101 |
| 2020 July | 62 | 12 | 74 |
| 2020 June | 65 | 19 | 84 |
| 2020 May | 54 | 19 | 73 |
| 2020 April | 21 | 18 | 39 |
| 2020 March | 37 | 5 | 42 |
| 2019 May | 0 | 2 | 2 |
| 2018 November | 0 | 1 | 1 |
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