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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2024;20:454-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Letter to the Editor in response to: “Spontaneous pneumomediastinum: An extra muscular manifestation of anti-MDA5 dermatomyositis. Report of 2 cases”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "454" "paginaFinal" => "455" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carta al editor en respuesta a: «Neumomediastino espontáneo: una manifestación extramuscular de la dermatomiositis anti-MDA5. Reporte de 2 casos»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1441 "Ancho" => 2216 "Tamanyo" => 225028 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposed classification of pneumomediastinum.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">* Precipitating factors can act upon predisposing factors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Santiago Campbell-Silva, Iyuleisa Castro-González, Santiago Campbell-Quintero, Sebastián Campbell-Quintero" 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=> array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Clinical Rheumatology</span>" "titulo" => "Multicentric reticulohistiocytosis: A 20-year diagnosis beneath the surface" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "456" "paginaFinal" => "457" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "David Fernández-Fernández, Ivonne Lourdes Mamani-Velarde, Maritza Tatiana Segarra-Ortega, José María Pego-Reigosa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "David" "apellidos" => "Fernández-Fernández" "email" => array:1 [ 0 => "David.fernandez.fernandez@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ivonne Lourdes" "apellidos" => "Mamani-Velarde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Maritza Tatiana" "apellidos" => "Segarra-Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "José María" "apellidos" => "Pego-Reigosa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Complexo Hospitalario de Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo IRIDIS (Investigation in Rheumatology and Immune-mediated Diseases), Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reticulohistiocitosis multicéntrica: un diagnóstico oculto durante 20 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2259 "Ancho" => 1583 "Tamanyo" => 441915 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old Caucasian male consulted for the appearance of nodular skin lesions in form on firm, raised bumps with a red-brown and yellowish hue on the dorsal surface of the hands, forearms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) and nasal region. He was followed in rheumatology outpatient clinic for 20 years with chronic erosive seronegative polyarthritis with erosions affecting mainly Distal Interphalangeal (DIP) joints (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). A combined therapy with methotrexate 20<span class="elsevierStyleHsp" style=""></span>mg plus etanercept 50<span class="elsevierStyleHsp" style=""></span>mg weekly was established with complete clinical remission at the onset of the lesions. A skin and metacarpophalangeal biopsy were performed. A proliferation of cells with a wide eosinophilic cytoplasm and the presence of multinucleated giant cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c) was observed. The immunohistochemical analysis reveals that the cells express CD45, CD68, CD11b, and HAM-56, but not the S100 or CD1a protein, compatible with histiocytosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Multicentric reticulohistiocytosis (MRH) with joint and disseminated skin involvement was diagnosed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Evolution</span><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous lesions improved spontaneously in three weeks. Eighteen months later, only a few lesions were seen on the forearms and dorsum of the hands. Due to the spontaneous improvement and the absence of impact on the patient's life, no modification of therapy was considered, and the previous treatment was maintained. No another involvement was referred in the follow-up. A PET-scan was considered to rule out malignancy, but the patient died prior the scheduled date due a respiratory sepsis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Multicentric reticulohistiocytosis (MRH) is a rare idiopathic systemic inflammatory disease characterized by a tissue infiltrate of non-Langerhans histiocytic cells primarily in joints and skin but also affecting other organ systems.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The disease often presents insidiously, beginning with articular symptoms and developing skin manifestations after a few months or even years. To our knowledge no report with such a long interval between articular and dermatological manifestations as in our patient (twenty years) has been described.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> This case, with an unusual lag between the presence of erosive joint involvement and the presence of skin lesions, highlights the importance of considering this entity in the differential diagnosis of patients with erosive joint lesions, predominantly in distal interphalangeal joints.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors’ contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">All authors contributed equally to the data collection, analysis, and writing of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patient consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient has provided informed consent for the publication of this case and the associated images.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Evolution" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Patient consent" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 7 => array:2 [ "identificador" => "xack780917" "titulo" => "Acknowledgements" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2259 "Ancho" => 1583 "Tamanyo" => 441915 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicentric reticulohistiocytosis – a rare and disabling disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Ashaolu" 1 => "S. Ng" 2 => "S. Smale" 3 => "J. Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccr3.7846" "Revista" => array:5 [ "tituloSerie" => "Clin Case Rep" "fecha" => "2023" "volumen" => "11" "paginaInicial" => "e7846" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37645054" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicentric reticulohistiocytosis: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Fujii" 1 => "M. Hasegawa" 2 => "K. Yano" 3 => "T. Fukuda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2020" "volumen" => "26" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack780917" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We thank Dr. Carmen Fachal Bermudez from the Pathology Service of the Complexo Hospitalario Universitario de Vigo for her collaboration in the diagnosis of this case.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000002000000008/v1_202410110607/S2173574324001175/v1_202410110607/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000002000000008/v1_202410110607/S2173574324001175/v1_202410110607/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574324001175?idApp=UINPBA00004M" ]
