Statistics

 array:24 [
  "pii" => "S2173574319301121"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2017.08.011"
  "estado" => "S300"
  "fechaPublicacion" => "2019-11-01"
  "aid" => "1122"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2019;15:e128-e129"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "HTML" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X17302334"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2017.08.009"
      "estado" => "S300"
      "fechaPublicacion" => "2019-11-01"
      "aid" => "1122"
      "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. 2019;15:e128-e129"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 897
        "formatos" => array:3 [
          "EPUB" => 56
          "HTML" => 490
          "PDF" => 351
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Hemot&#243;rax en s&#237;ndrome de Ehlers-Danlos tipo vascular"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e128"
            "paginaFinal" => "e129"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Hemothorax in vascular Ehlers-Danlos syndrome"
          ]
        ]
        "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" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1216
                "Ancho" => 1267
                "Tamanyo" => 113254
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Imagen de la TC de t&#243;rax en corte sagital&#46; Se observa la arteria mamaria interna y el hematoma que se origina de la rotura de la misma&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Kevin &#193;lvarez, L&#243;pez Jordi, Hern&#225;ndez Jose Angel"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Kevin"
                "apellidos" => "&#193;lvarez"
              ]
              1 => array:2 [
                "nombre" => "L&#243;pez"
                "apellidos" => "Jordi"
              ]
              2 => array:2 [
                "nombre" => "Hern&#225;ndez"
                "apellidos" => "Jose Angel"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574319301121"
          "doi" => "10.1016/j.reumae.2017.08.011"
          "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/S2173574319301121?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17302334?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001500000006/v1_201911200727/S1699258X17302334/v1_201911200727/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S217357431930111X"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.07.014"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1112"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e130-e132"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Visceral leishmaniasis in a patient with rheumatoid arthritis treated with methotrexate"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e130"
          "paginaFinal" => "e132"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leishmaniasis visceral en un paciente con artritis reumatoide en tratamiento con metotrexato"
        ]
      ]
      "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&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 934
              "Ancho" => 800
              "Tamanyo" => 99063
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bone marrow biopsy&#58; several macrophages can be seen with <span class="elsevierStyleItalic">Leishmania</span> amastigotes in their interior &#40;arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jes&#250;s Loarce-Martos, Sandra Garrote-Corral, Francesca Gioia, Javier Bachiller-Corral"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Loarce-Martos"
            ]
            1 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Garrote-Corral"
            ]
            2 => array:2 [
              "nombre" => "Francesca"
              "apellidos" => "Gioia"
            ]
            3 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Bachiller-Corral"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17302000"
        "doi" => "10.1016/j.reuma.2017.07.024"
        "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/S1699258X17302000?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431930111X?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S217357431930111X/v1_201911250632/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574319301145"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.08.012"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1123"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2019;15:e125-e127"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Gonococcal arthritis and C2 deficiency"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e125"
          "paginaFinal" => "e127"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Artritis gonoc&#243;cica y d&#233;ficit de C2"
        ]
      ]
      "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&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 819
              "Ancho" => 900
              "Tamanyo" => 91749
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Arthritis of both carpi with tenosynovitis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Diego Benavent N&#250;&#241;ez, Carolina Tornero Mar&#237;n, Gema Bonilla Hern&#225;n, Adela Garc&#237;a Perea, Alejandro Balsa Criado, Alicia Rico Nieto"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Diego"
              "apellidos" => "Benavent N&#250;&#241;ez"
            ]
            1 => array:2 [
              "nombre" => "Carolina"
              "apellidos" => "Tornero Mar&#237;n"
            ]
            2 => array:2 [
              "nombre" => "Gema"
              "apellidos" => "Bonilla Hern&#225;n"
            ]
            3 => array:2 [
              "nombre" => "Adela"
              "apellidos" => "Garc&#237;a Perea"
            ]
            4 => array:2 [
              "nombre" => "Alejandro"
              "apellidos" => "Balsa Criado"
            ]
            5 => array:2 [
              "nombre" => "Alicia"
              "apellidos" => "Rico Nieto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17302346"
        "doi" => "10.1016/j.reuma.2017.08.010"
        "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/S1699258X17302346?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301145?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301145/v1_201911250632/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Haemothorax in vascular Ehlers-Danlos syndrome"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e128"
        "paginaFinal" => "e129"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Kevin &#193;lvarez, Jordi L&#243;pez, Jose Angel Hern&#225;ndez"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Kevin"
            "apellidos" => "&#193;lvarez"
            "email" => array:1 [
              0 => "kevialv@yahoo.es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jordi"
            "apellidos" => "L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Jose Angel"
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Cardiolog&#237;a&#44; Complejo Hospitalario Universitario Insular-Materno Infantil&#44; Las Palmas de Gran Canaria&#44; Las Palmas&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Complejo Hospitalario Universitario Insular-Materno Infantil&#44; Las Palmas de Gran Canaria&#44; Las Palmas&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Complejo Hospitalario Universitario Insular-Materno Infantil&#44; Las Palmas de Gran Canaria&#44; Las Palmas&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hemot&#243;rax en s&#237;ndrome de Ehlers-Danlos tipo vascular"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1216
            "Ancho" => 1267
            "Tamanyo" => 114300
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CT image of the thorax&#44; sagittal view&#46; The internal mammary artery and the haematoma that originates from its rupture can be observed&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Type IV or vascular &#40;EDS IV&#41; Ehlers-Danlos syndrome is characterised by alterations in type III collagen metabolism by mutations of the COL3A1 gene&#46; It usually starts at a young age with spontaneous ruptures of medium-calibre arteries&#46; Its diagnosis requires a high level of suspicion in order to correctly direct the clinical history&#46; Its management involves a series of measures to prevent trauma or risk situations&#46; There is no effective pharmacological treatment&#44; only &#946;-blockers have been tried to prevent catastrophic bleeding&#46;</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 50-year-old male who was admitted to the pneumology department with a diagnosis of pneumonia associated with significant parapneumonic effusion&#59; the patient reported prior symptoms of influenza&#44; a coughing spell that triggered severe pain in the right haemothorax and presyncope symptoms&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Personal history of note included&#58; smoker of 30 packs&#47;year&#44; hypertension under treatment&#44; an episode of left carotid-cavernous fistula aged 25 treated by embolisation&#46; At 37 years he presented with symptoms of sudden abdominal pain resulting in spontaneous haemoperitoneum secondary to rupture of the round ligament&#44; confirmed in emergency surgery&#46; During the surgery&#44; splenic rupture occurred which required splenectomy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Family history of a father who died aged 30 years due to sudden death from an unexplained case&#46; Paternal grandmother died aged 50 from internal bleeding secondary to a ruptured axillary artery from mild trauma&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On physical examination&#58; cutis marmorata&#44; abundant haematomas on the upper limbs and thorax&#44; secondary to banal trauma&#44; slight hyperlaxity in metacarpophalangeal joints&#44; without typical facies&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pleural drainage of dense haematic content was performed&#44; after which a computed tomography &#40;CT&#41; of the thorax was performed which revealed the presence of a ruptured aneurysm of the right internal mammary artery&#44; causing ipsilateral haemothorax &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; He also had an aneurysm in the common hepatic artery&#46; Embolisation of the ruptured aneurysm was performed as treatment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">When EDS is suspected&#44; a confirmatory genetic study is carried out for the presence of heterozygosis in the splicing variant c&#46;636&#43;1G&#62;T in gene COL3A1&#46; The variant described is not recorded on the databases consulted&#44; but similar variants in the same point that are associated with type IV EDS are&#46; It is transmitted with autosomal dominant inheritance&#46; Once the suspected diagnosis has been confirmed&#44; the study is continued and the family is given genetic counselling&#44; and treatment is started with &#946;-blockers and controls in outpatient clinics&#46; After one year of follow-up&#44; the patient remains asymptomatic with no new bleeding episodes&#44; and under treatment with &#946;-blockers&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">EDS is a hereditary disease caused by mutations of the collagen gene with different subtypes&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> EDS IV is the most severe form&#46; It is inherited as an autosomal dominant trait and involves procollagen type III deficiency by mutation of the COL3A1 gene&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It constitutes between 5&#37; and 10&#37; of all cases of EDS&#44; with a prevalence of 1&#47;50 000&#8211;1&#47;200 000 inhabitants&#46; It is a potentially fatal variant&#44; increasing the risk of visceral and vascular rupture&#46; The absence of hyperelasticity of large joints stands out&#44; although the small distal joints of the hand may show moderate elasticity&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Diagnosis is based on the sum of clinical criteria and is confirmed by genetic study&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> There is no effective treatment&#44; although the administration of &#946;-blockers has been trialled previously to reduce catastrophic bleeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Follow-up includes minimising trauma&#44; identifying patients and creating a care group around them&#44; forming and facilitating individualised emergency plans&#44; centralising treatment in referral centres&#44; maintaining normal blood pressure and&#44; in the event of high blood pressure&#44; treating it strictly and monitoring the vascular tree by means of ultrasound&#44; CT-arteriography or nuclear magnetic resonance on an annual basis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">This is a rare disease&#44; difficult to diagnose&#46; With regard to genetic counselling and emergency management of the patient in the emergency department&#44; it is advisable to know the different possible manifestations to reach a quick suspicion and avoid complications&#46; It is important to avoid trauma&#44; and diagnostic or therapeutic vascular techniques that are not strictly necessary&#46;</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="par0055" class="elsevierStylePara elsevierViewall">The authors declare that neither human nor animal testing has been carried out in this research&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have complied with their work centre protocols for the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0065" 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="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1268388"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1173987"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1268387"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1173988"
          "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" => "2017-07-11"
    "fechaAceptado" => "2017-08-10"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1173987"
          "palabras" => array:3 [
            0 => "Ehlers-Danlos syndrome"
            1 => "EDS IV"
            2 => "Vascular Ehlers-Danlos syndrome"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1173988"
          "palabras" => array:3 [
            0 => "S&#237;ndrome de Ehlers-Danlos"
            1 => "SED IV"
            2 => "S&#237;ndrome de Ehlers-Danlos tipo vascular"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vascular Ehlers-Danlos syndrome &#40;EDS <span class="elsevierStyleSmallCaps">IV</span>&#41; is a rare genetic disorder characterised by an alteration in the COL3A1 gene which encodes type <span class="elsevierStyleSmallCaps">III</span> collagen&#46; It is the most common type of collagen in vessels of medium size and certain organs such as the intestines and the uterus&#46; The alteration of this type of collagen produces aneurisms and ruptures of vessels and organs&#46; A high level of clinical suspicion is required for diagnosis&#46; It is a complex disease whose management requires a multidisciplinary team to treat the different complications that may occur&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of a 50-year-old man diagnosed with EDS <span class="elsevierStyleSmallCaps">IV</span> detected incidentally after haemothorax secondary to a coughing spell&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Ehlers-Danlos de tipo vascular &#40;SED <span class="elsevierStyleSmallCaps">IV</span>&#41; se trata de una rara alteraci&#243;n gen&#233;tica causada por una alteraci&#243;n del gen COL3A1 que codifica el col&#225;geno tipo <span class="elsevierStyleSmallCaps">III</span>&#46; Este es el tipo de col&#225;geno m&#225;s frecuente en los vasos de mediano calibre y en algunos &#243;rganos como intestino y &#250;tero&#46; Su alteraci&#243;n produce&#44; entre otros&#44; aneurismas y roturas de vasos y &#243;rganos&#46; Para su diagn&#243;stico se requiere de un alto nivel de sospecha cl&#237;nica&#46; Se trata de una enfermedad de manejo complejo que requiere de un equipo multidisciplinar para tratar las diferentes complicaciones que pueden acontecer&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se presenta el caso de un paciente var&#243;n de 50 a&#241;os diagnosticado de SED <span class="elsevierStyleSmallCaps">IV</span> de forma incidental tras hemot&#243;rax secundario a acceso de tos&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; &#193;lvarez K&#44; L&#243;pez J&#44; Hern&#225;ndez JA&#46; Hemot&#243;rax en s&#237;ndrome de Ehlers-Danlos tipo vascular&#46; Reumatol Clin&#46; 2019&#59;15&#58;e128&#8211;e129&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1216
            "Ancho" => 1267
            "Tamanyo" => 114300
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CT image of the thorax&#44; sagittal view&#46; The internal mammary artery and the haematoma that originates from its rupture can be observed&#46;</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" => "COL3A1 mutations cause variable clinical phenotypes including acrogeria and vascular rupture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;M&#46; Pope"
                            1 => "P&#46; Narcisi"
                            2 => "A&#46;C&#46; Nicholls"
                            3 => "D&#46;P&#46; Germain"
                            4 => "G&#46; Pals"
                            5 => "A&#46;J&#46; Richards"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "1996"
                        "volumen" => "135"
                        "paginaInicial" => "163"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8881656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and genetic features of Ehlers-Danlos syndrome type IV&#44; the vascular type"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Pepin"
                            1 => "U&#46; Schwarze"
                            2 => "A&#46; Superti-Furga"
                            3 => "P&#46;H&#46; Byers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200003093421001"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "342"
                        "paginaInicial" => "673"
                        "paginaFinal" => "680"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10706896"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ehlers-Danlos syndrome type IV"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;G&#46; Pepin"
                            1 => "P&#46;H&#46; Byers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "editores" => "R&#46;A&#46;Pagon, T&#46;D&#46;Bird, C&#46;R&#46;Dolan"
                        "titulo" => "GeneReviews"
                        "serieFecha" => "1993"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers-Danlos syndrome&#58; a prospective randomised&#44; open&#44; blinded-endpoints trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;T&#46; Ong"
                            1 => "J&#46; Perdu"
                            2 => "J&#46; de Backer"
                            3 => "E&#46; Bozec"
                            4 => "P&#46; Collignon"
                            5 => "J&#46; Emmerich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(10)60960-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2010"
                        "volumen" => "376"
                        "paginaInicial" => "1476"
                        "paginaFinal" => "1484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20825986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of vascular Ehlers-Danlos syndrome&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Bergqvist"
                            1 => "M&#46; Bj&#246;rck"
                            2 => "A&#46; Wanhainen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e31829c7a59"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2013"
                        "volumen" => "258"
                        "paginaInicial" => "257"
                        "paginaFinal" => "261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23751452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis&#44; natural history and management in vascular Ehlers-Danlos syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;H&#46; Byers"
                            1 => "J&#46; Belmont"
                            2 => "J&#46; Black"
                            3 => "J&#46; de Backer"
                            4 => "M&#46; Frank"
                            5 => "X&#46; Jeunemaitre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ajmg.c.31553"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet Part C Semin Med Genet"
                        "fecha" => "2017"
                        "volumen" => "175"
                        "paginaInicial" => "40"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28306228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001500000006/v1_201911250632/S2173574319301121/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/S2173574319301121/v1_201911250632/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319301121?idApp=UINPBA00004M"
]