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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a systemic disease of unknown origin characterized by a non-caseating granulomatous reaction that can involves many tissues and organs&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Although the pathogenesis is not clear yet&#44; some genetic and environmental factors influence the cellular immune system activation and non-specific inflammatory response occurred&#46; T-helper 1 and proinflammatory cytokines from macrophages trigger inflammatory cascade and granuloma formation may occur as a result of tissue permeability&#44; cell influx&#44; and local cell proliferation&#46; Presence of non-caseating epithelioid cell granulomas is the indisputable pathological finding of sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> Different prevalence&#44; clinical signs and disease course in different ethnic and racial groups are indicative for sarcoidosis as being a heterogeneous disease&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> Its prevalence is high in female and it generally occurs at age of 40&#46; The incidence of sarcoidosis in USA is 10&#46;9&#47;100&#46;000 in white&#44; while in Afro-American this rate is 35&#46;5&#47;100&#46;000&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Adult onset Still&#39;s disease &#40;AOSD&#41; is a rare systemic inflammatory disease characterized by high fever&#44; transient skin rash&#44; arthritis and many organ involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> The incidence of the disease is 1&#8211;10&#47;1<span class="elsevierStyleHsp" style=""></span>mln&#44; the ratio of female to male is 2&#47;1&#44; and it is seen most frequently in 16&#8211;35 years of age&#46; Pathogenesis is not elucidated yet&#44; but it is thought to be a Th1-related disease&#46; As intensive cytokine release&#44; fever&#44; rash and association of serositis are similar characteristics of AOSD with autoinflammatory diseases&#59; there are those who advocate taking part of AOSD in this group of diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> There are insufficient data in the literature about the association of sarcoidosis and AOSD&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Herein we reported the coexistence of sarcoidosis and AOSD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case presentation</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 24-year-old male patient admitted to the Rheumatology polyclinic with complaints of arthritis of both ankle joints&#44; erythema nodosum and fatigue for about 4 years ago&#46; Chest disease consultation was made due to acute phase reactant elevation and detection of bilateral hilar lymphadenopathy at thorax computed tomography &#40;CT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Non-caseating granuloma was detected in endobronchial ultrasound &#40;EBUS&#41; biopsy which was made with sarcoidosis pre-diagnosis&#46; Sarcoidosis was diagnosed also due to high CD4&#47;CD8 ratio in the bronchoalveolar lavage &#40;BAL&#41; fluid&#44; typical thorax CT images and biopsy results&#46; The disease was controlled by low-dose corticosteroid therapy and drug was discontinued after about 1 year&#46; Six months after the treatment was discontinued&#44; patient applied to the Rheumatology polyclinic because of complaints of fever&#44; diffuse maculopapular skin rashes&#44; joint pain and morning stiffness&#46; In physical examination&#59; fever 39<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; bilateral axillary lymphadenopathy&#44; mild hepatosplenomegaly&#44; widespread skin rash&#44; tenderness and limitation of motion in knee&#44; wrist&#44; metacarpophalangeal &#40;MCP&#41; and proximal interphalangeal &#40;PIP&#41; joints were detected&#46; Laboratory tests revealed acute phase reactants and ferritin elevation&#46; Serological examinations including rheumatoid factor &#40;RF&#41;&#44; anti-nuclear antibody &#40;ANA&#41;&#44; anti-cytoplasmic antibody &#40;ANCA&#41;&#44; anti-cyclic citrullinated antibody &#40;anti-CCP&#41; were normal&#46; Due to the fever&#44; an infectious disease specialist consultation was made for possible infection&#44; no infection focus was detected&#46; Blood and urine culture results were negative&#46; Viral serologic tests &#40;EBV&#44; CMV&#44; HIV&#44; HBV&#44; HCV&#41; and Brucella tests were normal&#46; Peripheral blood smear was performed&#44; everything was normal except neutrophilic leukocytosis&#46; Hematology consultation was performed&#44; hematological malignancy was not considered&#46; Mild hepatosplenomegaly was detected in abdominal ultrasonography &#40;USG&#41; and axillary USG showed lymphadenopathy with 5&#8211;6 lymph nodes and the largest one was 12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; Chest X-ray and thorax CT were normal&#46; There were no findings suggestive of sarcoidosis activation&#46; According to clinical&#44; laboratory and serological tests the patient was diagnosed with AOSD and corticosteroids &#40;CS&#41;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day plus methotrexate &#40;MTX&#41; 15<span class="elsevierStyleHsp" style=""></span>mg&#47;week were started&#46; After 3 months&#44; there was a slight decrease in acute phase reactants&#44; but there was no significant decline in patient complaints and MTX dose was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#46; After 5months of treatment Tocilizumab was started in a rheumatology center to the patient who applied without any significant regression in his complaints&#46; Significant regression was observed in the patient&#39;s complaints at 6th month of this treatment&#44; acute phase reactants and serum ferritin levels were normalized&#46; Policlinic follow-up of the patient with good general condition and remission of the disease is continuing&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">In this paper&#44; we reported the coexistence of sarcoidosis and AOSD&#46; Our patient&#44; who was followed with diagnosis of sarcoidosis&#44; presenting with complaints of fever&#44; skin rash and arthritis and initially was hospitalized for sarcoidosis reactivation&#46; However&#44; because of the presence of rapidly fading maculopapular eruptions associated with fever&#44; lymphadenopathy&#44; hepatosplenomegaly&#44; elevated liver function tests and ferritin&#44; and after the exclusion of another underlying pathology&#46; Our patient was diagnosed as AOSD&#46; Patient was not responding to high doses CS and MTX&#44; disease was controlled after Tocilizumab treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some similar features of sarcoidosis and AOSD are available &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Etiopathogenesis of both diseases is unclear&#44; but they result in a Th1-weighted immune response at the genetic basis&#44; with the effect of some environmental factors and infectious agents&#46; The presence of prototypes &#40;Blau s&#47;m and juvenile chronic arthritis systemic form&#41; in childhood&#44; and similar cytokine profiles and similar clinical features &#40;such as fever&#44; skin and joint involvement&#44; lymphadenopathy and multiorgan involvement&#41; are some of the common features of both diseases&#46; In addition&#44; it is similar between both diseases that diagnosis of both disease can be made just after the exclusion of other diseases &#40;such as infection&#44; malignancy&#44; other rheumatic diseases&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">AOSD is a rare systemic inflammatory disease characterized by high fever&#44; transient maculopapular skin rash&#44; arthritis and many organ involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> Although the pathogenesis of the disease is unclear&#44; it is thought that it develops as a result of the immune system dysfunction in which Th1 cells plays important role&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Some infectious agents are also accused but no specific agent has been identified in cultures&#46; HLA DR2&#44; DR4&#44; DR7 and HLA B35 positivity is frequently seen in this patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> AOSD is an exclusionary diagnosis&#44; so the differential diagnosis must be done very well&#46; First of all&#44; infectious diseases&#44; malignancies and other rheumatic diseases that make this clinical picture should be excluded&#46; In distinguishing different connective tissue diseases&#44; ANA and RF negativity are important&#46; Besides significantly elevated ferritin levels are also helpful in diagnosis&#46; For this reason&#44; it is recommended that the patient should be examined for serum ferritin level&#44; especially if there are any rheumatologic findings&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> As in our patients&#44; high levels of ferritin can be a guide&#46; Since the AOSD does not have a specific laboratory finding and is not considered clinically preliminary&#44; the diagnosis is either skipped or diagnosed late&#46; Diagnostic criteria have been developed by different investigators and tested for their sensitivity and specificity&#46; The diagnostic criteria developed by Yamaguchi were reported to be 96&#37; sensitive and 92&#37; specific&#46; According to this criteria diagnosis can be made with more than 5 criteria&#44; 2 of which are major&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> In our patient&#44; three of the major criteria and four of the minor criteria were present&#46; In the light of this data&#44; our patient was diagnosed and treated as AOSD&#46; The disease should be treated according to the severity of the disease and organ involvement&#46; Although nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41; are recommended in the first place&#44; they have a very low effect and CSs and immunosuppressive drugs &#40;MTX&#44; azathioprin&#44; cyclosporin A&#41; have been shown to be more effective&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">12&#8211;14</span></a> CS doses during an acute exacerbation is usually 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day and it is effective in many patients&#46; Pulsed methyl prednisolone is used in severe hepatic involvement&#44; cardiac tamponade&#44; disseminated intravascular coagulation &#40;DIC&#41; or other life-threatening conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> The effects of biological agents have been shown in patients unresponsive to CS and immunosuppressive treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">16&#8211;18</span></a> Since our case was not responded to high dose CS and MTX treatment&#44; Tocilizumab was started&#46; With this treatment&#44; the disease is under control and it is now in remission&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; we reported the development of AOSD in a patient with a diagnosis of sarcoidosis&#46; Since sarcoidosis and AOSD have some similar characteristics&#44; differential diagnosis must be performed well&#46; When symptoms such as fever&#44; arthritis&#44; skin rash developed in patients with sarcoidosis&#44; AOSD should be considered in addition to activation of sarcoidosis&#46; The coexistence of these two diseases&#44; which are imitators of many different diseases&#44; can be a coincidence and&#47;or they might have a common etiopathogenesis&#46; More research is needed in this regard&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">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&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">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&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "titulo" => "Abstract"
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              "identificador" => "abst0005"
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        1 => array:2 [
          "identificador" => "xpalclavsec1165519"
          "titulo" => "Keywords"
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        2 => array:3 [
          "identificador" => "xres1258186"
          "titulo" => "Resumen"
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            0 => array:1 [
              "identificador" => "abst0010"
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        3 => array:2 [
          "identificador" => "xpalclavsec1165520"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case presentation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of interests"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-03-16"
    "fechaAceptado" => "2017-04-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1165519"
          "palabras" => array:3 [
            0 => "Sarcoidosis"
            1 => "Adult onset Still&#39;s disease"
            2 => "Coexistence"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1165520"
          "palabras" => array:3 [
            0 => "Sarcoidosis"
            1 => "Enfermedad de Still del adulto"
            2 => "Coexistencia"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis is a chronic&#44; inflammatory disease with unknown cause characterized by non-caseating granuloma formations&#46; It can be presented with bilateral hilar lymphadenopathy&#44; skin lesions&#44; eye involvement and locomotor system findings&#46; Adult onset Still disease &#40;AOSD&#41; is a chronic inflammatory disease which presents with fever&#44; arthritis and typical skin rashes&#46; The disease is rare and can be misdiagnosed due to the absence of typical clinical and laboratory findings&#46; The association of sarcoidosis and AOSD has not been previously reported in the literature&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Herein we reported the development of AOSD in a patient followed by the diagnosis of sarcoidosis&#46; The patient did not respond to high-dose corticosteroids and methotrexate therapy&#44; and the disease was under control with anti-IL-6 &#40;Tocilizumab&#41; drug&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis es una enfermedad inflamatoria cr&#243;nica de causa desconocida&#44; que se caracteriza por formaciones de granulomas no caseificantes&#46; Puede presentarse como linfadenopat&#237;a hiliar bilateral&#44; lesiones cut&#225;neas&#44; compromiso ocular y del sistema locomotor&#46; La enfermedad de Still del adulto &#40;AOSD&#41; es una enfermedad inflamatoria cr&#243;nica que se presenta con fiebre&#44; artritis y erupciones cut&#225;neas t&#237;picas&#46; Dicha enfermedad es rara y puede diagnoticarse err&#243;neamente debido a la ausencia de rasgos cl&#237;nicos y de laboratorio t&#237;picos&#46; En la literatura no se ha reportado previamente la asociaci&#243;n entre sarcoidosis y AOSD&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reportamos aqu&#237; el desarrollo de AOSD en un paciente sometido a seguimiento debido a diagn&#243;stico de sarcoidosis&#46; El paciente no respondi&#243; al tratamiento con altas dosis de corticosteroides y metotrexato&#44; manteni&#233;ndose la enfermedad bajo control con un f&#225;rmaco anti-IL-6 &#40;Tocilizumab&#41;&#46;</p></span>"
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Torax CT of the patient showed bilateral hilar lymphadenopaties&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; IL &#8211; interleukine&#59; TNFA &#8211; tumor necrosis factor alpha&#59; TGF-B &#8211; transforming growth factor beta&#59; JCA &#8211; juvenile chronic arthritis&#44; IFN &#8211; interferon&#59; HLA &#8211; human leukocyte antigen&#59; Th1 &#8211; T-helper 1&#59; ANA &#8211; antinuclear antibody&#59; RF &#8211; rheumatoid factor&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adult onset Still disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patogenez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Th1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Th1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genetik&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DRB1&#44; DQB1&#44; HLA-B5&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DR2&#47;4&#47;7&#44; DR-B1&#44; HLA-B35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cytokines profile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-1&#44; IL-6&#44; IL-17&#44; TNFA&#44; TGF-B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-1&#44; IL-6&#44; IL-18&#44; TNFA&#44; IFN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infectious agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viruses&#44; bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viruses&#44; bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Childhood prototype disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;Blau s&#47;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;JCA-systemic form&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANA&#47;RF&#47;ANCA&#47;anti-CCP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negatif&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negatif&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exlusion diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment-KS&#44; IS&#44; biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis vs&#46; adult onset Still&#39;s disease &#8211; common similarities&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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Case report
Coexistence of sarcoidosis and adult onset Still disease
Coexistencia de sarcoidosis y enfermedad de Still del adulto
Huseyin Semiza, Senol Kobakb,
Corresponding author
senolkobak@gmail.com

Corresponding author.
a Ege University, Faculty of Medicine, Department of Internal Medicine, Turkey
b Istinye University, Faculty of Medicine, Department of Rheumatology, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a systemic disease of unknown origin characterized by a non-caseating granulomatous reaction that can involves many tissues and organs&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Although the pathogenesis is not clear yet&#44; some genetic and environmental factors influence the cellular immune system activation and non-specific inflammatory response occurred&#46; T-helper 1 and proinflammatory cytokines from macrophages trigger inflammatory cascade and granuloma formation may occur as a result of tissue permeability&#44; cell influx&#44; and local cell proliferation&#46; Presence of non-caseating epithelioid cell granulomas is the indisputable pathological finding of sarcoidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> Different prevalence&#44; clinical signs and disease course in different ethnic and racial groups are indicative for sarcoidosis as being a heterogeneous disease&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> Its prevalence is high in female and it generally occurs at age of 40&#46; The incidence of sarcoidosis in USA is 10&#46;9&#47;100&#46;000 in white&#44; while in Afro-American this rate is 35&#46;5&#47;100&#46;000&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Adult onset Still&#39;s disease &#40;AOSD&#41; is a rare systemic inflammatory disease characterized by high fever&#44; transient skin rash&#44; arthritis and many organ involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> The incidence of the disease is 1&#8211;10&#47;1<span class="elsevierStyleHsp" style=""></span>mln&#44; the ratio of female to male is 2&#47;1&#44; and it is seen most frequently in 16&#8211;35 years of age&#46; Pathogenesis is not elucidated yet&#44; but it is thought to be a Th1-related disease&#46; As intensive cytokine release&#44; fever&#44; rash and association of serositis are similar characteristics of AOSD with autoinflammatory diseases&#59; there are those who advocate taking part of AOSD in this group of diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> There are insufficient data in the literature about the association of sarcoidosis and AOSD&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Herein we reported the coexistence of sarcoidosis and AOSD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case presentation</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 24-year-old male patient admitted to the Rheumatology polyclinic with complaints of arthritis of both ankle joints&#44; erythema nodosum and fatigue for about 4 years ago&#46; Chest disease consultation was made due to acute phase reactant elevation and detection of bilateral hilar lymphadenopathy at thorax computed tomography &#40;CT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Non-caseating granuloma was detected in endobronchial ultrasound &#40;EBUS&#41; biopsy which was made with sarcoidosis pre-diagnosis&#46; Sarcoidosis was diagnosed also due to high CD4&#47;CD8 ratio in the bronchoalveolar lavage &#40;BAL&#41; fluid&#44; typical thorax CT images and biopsy results&#46; The disease was controlled by low-dose corticosteroid therapy and drug was discontinued after about 1 year&#46; Six months after the treatment was discontinued&#44; patient applied to the Rheumatology polyclinic because of complaints of fever&#44; diffuse maculopapular skin rashes&#44; joint pain and morning stiffness&#46; In physical examination&#59; fever 39<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; bilateral axillary lymphadenopathy&#44; mild hepatosplenomegaly&#44; widespread skin rash&#44; tenderness and limitation of motion in knee&#44; wrist&#44; metacarpophalangeal &#40;MCP&#41; and proximal interphalangeal &#40;PIP&#41; joints were detected&#46; Laboratory tests revealed acute phase reactants and ferritin elevation&#46; Serological examinations including rheumatoid factor &#40;RF&#41;&#44; anti-nuclear antibody &#40;ANA&#41;&#44; anti-cytoplasmic antibody &#40;ANCA&#41;&#44; anti-cyclic citrullinated antibody &#40;anti-CCP&#41; were normal&#46; Due to the fever&#44; an infectious disease specialist consultation was made for possible infection&#44; no infection focus was detected&#46; Blood and urine culture results were negative&#46; Viral serologic tests &#40;EBV&#44; CMV&#44; HIV&#44; HBV&#44; HCV&#41; and Brucella tests were normal&#46; Peripheral blood smear was performed&#44; everything was normal except neutrophilic leukocytosis&#46; Hematology consultation was performed&#44; hematological malignancy was not considered&#46; Mild hepatosplenomegaly was detected in abdominal ultrasonography &#40;USG&#41; and axillary USG showed lymphadenopathy with 5&#8211;6 lymph nodes and the largest one was 12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46; Chest X-ray and thorax CT were normal&#46; There were no findings suggestive of sarcoidosis activation&#46; According to clinical&#44; laboratory and serological tests the patient was diagnosed with AOSD and corticosteroids &#40;CS&#41;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day plus methotrexate &#40;MTX&#41; 15<span class="elsevierStyleHsp" style=""></span>mg&#47;week were started&#46; After 3 months&#44; there was a slight decrease in acute phase reactants&#44; but there was no significant decline in patient complaints and MTX dose was increased to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#46; After 5months of treatment Tocilizumab was started in a rheumatology center to the patient who applied without any significant regression in his complaints&#46; Significant regression was observed in the patient&#39;s complaints at 6th month of this treatment&#44; acute phase reactants and serum ferritin levels were normalized&#46; Policlinic follow-up of the patient with good general condition and remission of the disease is continuing&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">In this paper&#44; we reported the coexistence of sarcoidosis and AOSD&#46; Our patient&#44; who was followed with diagnosis of sarcoidosis&#44; presenting with complaints of fever&#44; skin rash and arthritis and initially was hospitalized for sarcoidosis reactivation&#46; However&#44; because of the presence of rapidly fading maculopapular eruptions associated with fever&#44; lymphadenopathy&#44; hepatosplenomegaly&#44; elevated liver function tests and ferritin&#44; and after the exclusion of another underlying pathology&#46; Our patient was diagnosed as AOSD&#46; Patient was not responding to high doses CS and MTX&#44; disease was controlled after Tocilizumab treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some similar features of sarcoidosis and AOSD are available &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Etiopathogenesis of both diseases is unclear&#44; but they result in a Th1-weighted immune response at the genetic basis&#44; with the effect of some environmental factors and infectious agents&#46; The presence of prototypes &#40;Blau s&#47;m and juvenile chronic arthritis systemic form&#41; in childhood&#44; and similar cytokine profiles and similar clinical features &#40;such as fever&#44; skin and joint involvement&#44; lymphadenopathy and multiorgan involvement&#41; are some of the common features of both diseases&#46; In addition&#44; it is similar between both diseases that diagnosis of both disease can be made just after the exclusion of other diseases &#40;such as infection&#44; malignancy&#44; other rheumatic diseases&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">AOSD is a rare systemic inflammatory disease characterized by high fever&#44; transient maculopapular skin rash&#44; arthritis and many organ involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> Although the pathogenesis of the disease is unclear&#44; it is thought that it develops as a result of the immune system dysfunction in which Th1 cells plays important role&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Some infectious agents are also accused but no specific agent has been identified in cultures&#46; HLA DR2&#44; DR4&#44; DR7 and HLA B35 positivity is frequently seen in this patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> AOSD is an exclusionary diagnosis&#44; so the differential diagnosis must be done very well&#46; First of all&#44; infectious diseases&#44; malignancies and other rheumatic diseases that make this clinical picture should be excluded&#46; In distinguishing different connective tissue diseases&#44; ANA and RF negativity are important&#46; Besides significantly elevated ferritin levels are also helpful in diagnosis&#46; For this reason&#44; it is recommended that the patient should be examined for serum ferritin level&#44; especially if there are any rheumatologic findings&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> As in our patients&#44; high levels of ferritin can be a guide&#46; Since the AOSD does not have a specific laboratory finding and is not considered clinically preliminary&#44; the diagnosis is either skipped or diagnosed late&#46; Diagnostic criteria have been developed by different investigators and tested for their sensitivity and specificity&#46; The diagnostic criteria developed by Yamaguchi were reported to be 96&#37; sensitive and 92&#37; specific&#46; According to this criteria diagnosis can be made with more than 5 criteria&#44; 2 of which are major&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> In our patient&#44; three of the major criteria and four of the minor criteria were present&#46; In the light of this data&#44; our patient was diagnosed and treated as AOSD&#46; The disease should be treated according to the severity of the disease and organ involvement&#46; Although nonsteroidal anti-inflammatory drugs &#40;NSAIDs&#41; are recommended in the first place&#44; they have a very low effect and CSs and immunosuppressive drugs &#40;MTX&#44; azathioprin&#44; cyclosporin A&#41; have been shown to be more effective&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">12&#8211;14</span></a> CS doses during an acute exacerbation is usually 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day and it is effective in many patients&#46; Pulsed methyl prednisolone is used in severe hepatic involvement&#44; cardiac tamponade&#44; disseminated intravascular coagulation &#40;DIC&#41; or other life-threatening conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> The effects of biological agents have been shown in patients unresponsive to CS and immunosuppressive treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">16&#8211;18</span></a> Since our case was not responded to high dose CS and MTX treatment&#44; Tocilizumab was started&#46; With this treatment&#44; the disease is under control and it is now in remission&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; we reported the development of AOSD in a patient with a diagnosis of sarcoidosis&#46; Since sarcoidosis and AOSD have some similar characteristics&#44; differential diagnosis must be performed well&#46; When symptoms such as fever&#44; arthritis&#44; skin rash developed in patients with sarcoidosis&#44; AOSD should be considered in addition to activation of sarcoidosis&#46; The coexistence of these two diseases&#44; which are imitators of many different diseases&#44; can be a coincidence and&#47;or they might have a common etiopathogenesis&#46; More research is needed in this regard&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">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&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">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&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1165520"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case presentation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of interests"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-03-16"
    "fechaAceptado" => "2017-04-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1165519"
          "palabras" => array:3 [
            0 => "Sarcoidosis"
            1 => "Adult onset Still&#39;s disease"
            2 => "Coexistence"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1165520"
          "palabras" => array:3 [
            0 => "Sarcoidosis"
            1 => "Enfermedad de Still del adulto"
            2 => "Coexistencia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis is a chronic&#44; inflammatory disease with unknown cause characterized by non-caseating granuloma formations&#46; It can be presented with bilateral hilar lymphadenopathy&#44; skin lesions&#44; eye involvement and locomotor system findings&#46; Adult onset Still disease &#40;AOSD&#41; is a chronic inflammatory disease which presents with fever&#44; arthritis and typical skin rashes&#46; The disease is rare and can be misdiagnosed due to the absence of typical clinical and laboratory findings&#46; The association of sarcoidosis and AOSD has not been previously reported in the literature&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Herein we reported the development of AOSD in a patient followed by the diagnosis of sarcoidosis&#46; The patient did not respond to high-dose corticosteroids and methotrexate therapy&#44; and the disease was under control with anti-IL-6 &#40;Tocilizumab&#41; drug&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis es una enfermedad inflamatoria cr&#243;nica de causa desconocida&#44; que se caracteriza por formaciones de granulomas no caseificantes&#46; Puede presentarse como linfadenopat&#237;a hiliar bilateral&#44; lesiones cut&#225;neas&#44; compromiso ocular y del sistema locomotor&#46; La enfermedad de Still del adulto &#40;AOSD&#41; es una enfermedad inflamatoria cr&#243;nica que se presenta con fiebre&#44; artritis y erupciones cut&#225;neas t&#237;picas&#46; Dicha enfermedad es rara y puede diagnoticarse err&#243;neamente debido a la ausencia de rasgos cl&#237;nicos y de laboratorio t&#237;picos&#46; En la literatura no se ha reportado previamente la asociaci&#243;n entre sarcoidosis y AOSD&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Reportamos aqu&#237; el desarrollo de AOSD en un paciente sometido a seguimiento debido a diagn&#243;stico de sarcoidosis&#46; El paciente no respondi&#243; al tratamiento con altas dosis de corticosteroides y metotrexato&#44; manteni&#233;ndose la enfermedad bajo control con un f&#225;rmaco anti-IL-6 &#40;Tocilizumab&#41;&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      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" => 1524
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Torax CT of the patient showed bilateral hilar lymphadenopaties&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; IL &#8211; interleukine&#59; TNFA &#8211; tumor necrosis factor alpha&#59; TGF-B &#8211; transforming growth factor beta&#59; JCA &#8211; juvenile chronic arthritis&#44; IFN &#8211; interferon&#59; HLA &#8211; human leukocyte antigen&#59; Th1 &#8211; T-helper 1&#59; ANA &#8211; antinuclear antibody&#59; RF &#8211; rheumatoid factor&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adult onset Still disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patogenez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Th1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Th1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genetik&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DRB1&#44; DQB1&#44; HLA-B5&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DR2&#47;4&#47;7&#44; DR-B1&#44; HLA-B35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cytokines profile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-1&#44; IL-6&#44; IL-17&#44; TNFA&#44; TGF-B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-1&#44; IL-6&#44; IL-18&#44; TNFA&#44; IFN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infectious agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viruses&#44; bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viruses&#44; bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Childhood prototype disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;Blau s&#47;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;JCA-systemic form&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANA&#47;RF&#47;ANCA&#47;anti-CCP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negatif&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negatif&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exlusion diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment-KS&#44; IS&#44; biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2151617.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis vs&#46; adult onset Still&#39;s disease &#8211; common similarities&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;S&#46; Newman"
                            1 => "C&#46;S&#46; Rose"
                            2 => "L&#46;A&#46; Maier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199704243361706"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1997"
                        "volumen" => "336"
                        "paginaInicial" => "1224"
                        "paginaFinal" => "1234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9110911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genome-wide association study identifies ANXA11 as a new susceptibility locus for sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Hofmann"
                            1 => "A&#46; Franke"
                            2 => "A&#46; Fischer"
                            3 => "G&#46; Jacobs"
                            4 => "M&#46; Nothnagel"
                            5 => "K&#46;I&#46; Gaede"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ng.198"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Genet"
                        "fecha" => "2008"
                        "volumen" => "40"
                        "paginaInicial" => "1103"
                        "paginaFinal" => "1106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19165924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology of sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;S&#46; Chen"
                            1 => "D&#46;R&#46; Moller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "365"
                        "paginaFinal" => "377"
                      ]
                    ]
                  ]
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Idiomas
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