Case Report
Pulmonary Sarcoidosis Mimicking Tuberculosis: Importance of the Galaxy Sign on Thoracic Computed Tomography
Sarcoidosis pulmonar simulando una tuberculosis: importancia del signo de la galaxia en TC de tórax
Luis Gorospe Sarasúaa,
, Almudena Ureña-Vacasa, Paola Arrietab, Astrid Lucía Santos-Carreñoc, Enrique Navas-Elorzad, Carlos de la Puente-Bujidose
Corresponding author
a Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
c Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, Spain
d Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
e Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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=> "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Carlos" "apellidos" => "de la Puente-Bujidos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis pulmonar simulando una tuberculosis: importancia del signo de la galaxia en TC de tórax" ] ] "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" => 1662 "Ancho" => 2000 "Tamanyo" => 331589 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray where a nodular opacity in the URL is observed (arrows). (B) Axial image of the first chest CT (window of pulmonary parenchyma) in which a nodular lesion of ground-glass attenuation is observed (arrow). (C) MIP (maximum intensity projection) axial image of the second chest CT (window of pulmonary parenchyma) in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign: solid nodular opacities (arrows) surrounded by multiple solid 1–2<span class="elsevierStyleHsp" style=""></span>mm nodules. (D) Coronal imaging of SPECT/CT with gallium in which uptake by the pulmonary nodules (white arrows) is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum (black arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are two common granulomatous chest conditions which share clinical and radiological presentations. As a result they are often diagnostic challenges for clinicians and radiologists.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Among the standard radiologic signs of sarcoidosis recently described in chest CT is the sarcoid galaxy sign. This sign consists of a lung nodule formed by the confluence of multiple small-sized nodules which separate from one another as they move away from the centre, and thus portray a similarity to a galaxy of stars.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> We present a case of sarcoidosis which was initially misdiagnosed as tuberculosis and for which the galaxy sign was useful for indicating correct diagnosis within the clinical and radiologic context.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 42 year-old woman, a non-smoker, of Brazilian origin, who presented with an intermittent cough, for whom a chest X-ray showed nodular opacity in the URL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The patient had been studied some months previously by the primary care physician after non cohabitant contact with a case of tuberculosis, and a positive tuberculin test. A chest CT scan confirmed pseudonodular opacity in the URL of ground-glass attenuation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). No enlarged lymph nodes, tree-in-bud opacities or radiological stigmas (calcified granulomas, bronchiectases, calcified adenopathies) were observed from previous tuberculosis. Although the tuberculin test was positive, bronchoalveolar lavage (BAL) and a transbronchial biopsy did not show any microbiological or granuloma changes. Several sputum smears tested negative as well. Despite the absence of microbiological confirmation it was decided the patient was to be treated with 4 antituberculosis drugs. A control chest X-ray four months following treatment initiation showed radiological worsening with the appearance of bilateral parenchymal opacities. However, the patient did not present with new symptoms. A further chest CT scan detected enlarged lymph nodes without necrosis in the right pulmonary hilum and ipsilateral mediastinum, together with various dominant solid pulmonary nodules which characteristically presented with innumerable satellite 1–2<span class="elsevierStyleHsp" style=""></span>mm nodules around them (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a><span class="elsevierStyleSmallCaps">C</span>). This radiological presentation is called the galaxy sign. No tree-in-bud images or carious lesions were observed. In view of these findings, stage II pulmonary sarcoidosis was diagnosed. Fine needle aspiration endobronchial ultrasound guided biopsy (EBUS) of the enlarged lymph nodes demonstrated the presence of non-necrotising epithelioid granulomas, confirming the clinical diagnosis of sarcoidosis. No microbacteria were isolated in the BAL. Single-photo emission CT (SPECT) with gallium (67<span class="elsevierStyleHsp" style=""></span>Ga) was combined with CT (SPECT/TC) which showed metabolic uptakes in the dominant pulmonary nodules and in the enlarged lymph nodes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Tuberculosis and sarcoidosis are 2 granulomatous diseases which usually mostly affect the chest and which may present clinical, radiological and even histological similarities.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> This peculiarity means that differential diagnosis between these 2 conditions presents a challenge to clinicians, and particularly in countries where the incidence of tuberculosis is high.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Studies have demonstrated that microbacterial antigens may trigger immunological response and eventually induce sarcoidosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> However, patients with sarcoidosis treated with corticoids may present with tuberculosis as an infectious complication.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our case, a non-cohabitant contact of the patient with a case of tuberculosis (some months earlier), together with a positive tuberculin test and an X-ray arousing suspicion were “sufficient” to justify treatment initiation with antituberculosis drugs, despite the absence of microbiological confirmation in sputum smears and the BAL. The appearance of non-necrotising enlarged lymph nodes in a further chest CT, the absence of standard tuberculosis radiological stigma (calcified adenopathies and granulomas, bronchiectasis, etc.) and above all the galaxy sign indicated that sarcoidosis was responsible for the clinical and radiological symptoms. This suspicion was finally confirmed in the EBUS performed on the patients several weeks later. The galaxy sign was originally described in 2002 in chest CT studies of patients with sarcoidosis (although it is not specific of this entity) and consists of a central dominant pulmonary nodule formed by the confluence of many small-sized nodules.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> These tiny nodules separate from one another as they fade away from the dominant nodule, forming satellite nodules which look like a galaxy of stars. Histologically the galaxy sign represents the coalescence of many interstitial granulomas which form an inseparable large dominant nodule. On the periphery, the granulomas are less concentrated and separate from one another, forming satellite nodules. Although this sign was initially described in patients with sarcoidosis (in fact the term “sarcoid galaxy” was coined) it has also been described as being associated with massive progressive fibrosis in patients with silicosis, with some pulmonary tumours and on occasion with active tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In the immense majority of cases the usefulness of the galaxy sign indicates a benign type of pulmonary tumour. The only exception to this would be that of a peripheral lung adenocarcinoma small in size, although in this case, bilateral and symmetrical adenopathies are not usually found in the mediastinum and the pulmonary hilar structures (as occurs in sarcoidosis), nor signs of infectious bronchiolitis with necrotic enlarged lymph nodes (as occurs in tuberculosis) nor radiological signs of a complicated type of silicosis. In our specific case it was not just the galaxy sign in isolation, that suggested correct diagnosis of sarcoidosis, but the combination of this radiological finding in a patient with radiological worsening of lung injuries despite having received antituberculosis treatment, together with the appearance of mediastinal adenopathies.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that in some clinical and radiological contexts, and especially if there is radiological progression despite antituberculosis treatment or if there is no microbiological confirmation of microbacteria or radiological stigmas which are typical of tuberculosis, the galaxy sign in chest CT may be highly useful for indicating diagnosis of sarcoidosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to their centre of work on the publication of patient data.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1268391" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1173992" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1268392" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1173991" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Observation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-17" "fechaAceptado" => "2017-07-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1173992" "palabras" => array:4 [ 0 => "Sarcoidosis" 1 => "Tuberculosis" 2 => "Computed tomography" 3 => "Galaxy sign" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1173991" "palabras" => array:4 [ 0 => "Sarcoidosis" 1 => "Tuberculosis" 2 => "Tomografía computarizada" 3 => "Signo de la galaxia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis and tuberculosis are two common granulomatous conditions that may share clinical and radiological presentations. The galaxy sign (sarcoid galaxy sign) is a characteristic radiological sign of pulmonary sarcoidosis on thoracic computed tomography (CT). We present the case of a patient with sarcoidosis that was initially misdiagnosed as tuberculosis, in whom the galaxy sign on CT was useful as it suggested the correct diagnosis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis y la tuberculosis son 2 enfermedades granulomatosas frecuentes que comparten presentaciones clínicas y radiológicas. Entre los signos radiológicos característicos de sarcoidosis pulmonar descritos recientemente en la tomografía computarizada de tórax destaca el signo de la «galaxia». Presentamos un caso de sarcoidosis que inicialmente fue confundido con una tuberculosis en el que este signo radiológico fue útil para indicar el diagnóstico correcto.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Ureña-Vacas A, Arrieta P, Santos-Carreño AL, Navas-Elorza E, de la Puente-Bujidos C. Sarcoidosis pulmonar simulando una tuberculosis: importancia del signo de la galaxia en TC de tórax. Reumatol Clin. 2019;15:e133–e135.</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" => 1662 "Ancho" => 2000 "Tamanyo" => 331589 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray where a nodular opacity in the URL is observed (arrows). (B) Axial image of the first chest CT (window of pulmonary parenchyma) in which a nodular lesion of ground-glass attenuation is observed (arrow). (C) MIP (maximum intensity projection) axial image of the second chest CT (window of pulmonary parenchyma) in which a radiological progression is observed despite antituberculosis treatment and the galaxy sign: solid nodular opacities (arrows) surrounded by multiple solid 1–2<span class="elsevierStyleHsp" style=""></span>mm nodules. (D) Coronal imaging of SPECT/CT with gallium in which uptake by the pulmonary nodules (white arrows) is determined and by the right pulmonary hilar adenopathies and ipsilateral mediastinum (black arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Gupta" 1 => "R. Agarwal" 2 => "A.N. Aggarwal" 3 => "S.K. Jindal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "506" "paginaFinal" => "516" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis: role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Mortaz" 1 => "I.M. Adcock" 2 => "P.J. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijmyco.2014.10.008" "Revista" => array:6 [ "tituloSerie" => "Int J Mycobacteriol" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "225" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26786620" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Large coalescent parenchymal nodules in pulmonary sarcoidosis: Sarcoid galaxy sign" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Nakatsu" 1 => "H. Hatabu" 2 => "K. Morikawa" 3 => "H. Uematsu" 4 => "Y. Ohno" 5 => "K. Nishimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.178.6.1781389" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2002" "volumen" => "178" "paginaInicial" => "1389" "paginaFinal" => "1393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12034602" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular evidence for the role of mycobacteria in sarcoidosis: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Gupta" 1 => "R. Agarwal" 2 => "A.N. Aggarwal" 3 => "S.K. Jindal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00002607" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "508" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17537780" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of opportunistic diseases complicating sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Jamilloux" 1 => "D. Valeyre" 2 => "O. Lortholary" 3 => "C. Bernard" 4 => "S. Kerever" 5 => "L. Lelievre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2014.10.006" "Revista" => array:6 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "64" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25305373" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Galaxy sign" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Aikins" 1 => "J.P. Kanne" 2 => "J.H. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RTI.0b013e31826b7e6f" "Revista" => array:5 [ "tituloSerie" => "J Thorac Imaging" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "W164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059737" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.assets" "Apartado" => array:4 [ "identificador" => "80960" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000006/v1_201911250632/S2173574318301588/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301588?idApp=UINPBA00004M" ]
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