Case report
Juvenile Systemic Lupus Erythematosus associated with Klinefelter's syndrome: A case report
Lupus eritematoso sistémico de inicio juvenil asociado con el síndrome de klinefelter: un informe de casos
Leído
11683
Vecesse ha leído el artículo
3212
Total PDF
8471
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1699258X10000537" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2009.09.016" "estado" => "S300" "fechaPublicacion" => "2010-07-01" "aid" => "172" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2009" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2010;6:212-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5339 "formatos" => array:3 [ "EPUB" => 169 "HTML" => 4144 "PDF" => 1026 ] ] "itemSiguiente" => array:18 [ "pii" => "S1699258X10000458" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2009.07.011" "estado" => "S300" "fechaPublicacion" => "2010-07-01" "aid" => "164" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2010;6:214-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8533 "formatos" => array:3 [ "EPUB" => 151 "HTML" => 7017 "PDF" => 1365 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Pseudotumor orbitario refractario tratado con rituximab en paciente con lupus eritematoso sistémico. A propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "214" "paginaFinal" => "216" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Resistant orbital pseudotumor treated with rituximab in a patient with systemic lupus erythematosus. A case presentation" ] ] "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" => "fig1" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 441 "Ancho" => 972 "Tamanyo" => 84442 ] ] "descripcion" => array:1 [ "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Visión parasagital (izquierda) y coronal (derecha) de resonancia magnética nuclear orbitaria donde se observa una gran lesión ocupante de espacio intraorbitaria (flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen María Escudero González, Sergio Rodríguez Montero, Rosalía Martínez Pérez, Carolina Pastor Mañosa, María Luisa Velloso Feijoo, José Luis Marenco de la Fuente" "autores" => array:6 [ 0 => array:3 [ "Iniciales" => "C.M." "nombre" => "Carmen María" "apellidos" => "Escudero González" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "Rodríguez Montero" ] 2 => array:3 [ "Iniciales" => "R." "nombre" => "Rosalía" "apellidos" => "Martínez Pérez" ] 3 => array:2 [ "nombre" => "Carolina" "apellidos" => "Pastor Mañosa" ] 4 => array:3 [ "Iniciales" => "M.L." "nombre" => "María Luisa" "apellidos" => "Velloso Feijoo" ] 5 => array:3 [ "Iniciales" => "J.L." "nombre" => "José Luis" "apellidos" => "Marenco de la Fuente" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X10000458?idApp=UINPBA00004M" "url" => "/1699258X/0000000600000004/v1_201305061831/S1699258X10000458/v1_201305061831/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1699258X10000495" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2009.11.001" "estado" => "S300" "fechaPublicacion" => "2010-07-01" "aid" => "168" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2010;6:203-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9464 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 8134 "PDF" => 1146 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Análisis farmacoeconómico de Metoject<span class="elsevierStyleSup">®</span> en el tratamiento de la artritis reumatoide en España" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203" "paginaFinal" => "211" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pharmacoeconomic analysis of Metoject<span class="elsevierStyleSup">®</span> in the treatment of rheumatoid arthritis in Spain" ] ] "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" => "fig3" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1694 "Ancho" => 2920 "Tamanyo" => 389869 ] ] "descripcion" => array:1 [ "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Impacto presupuestario de Metoject<span class="elsevierStyleSup">®</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Crespo, Max Brosa, Jordi Galván, Jordi Carbonell, Jordi Maymó, José Luis Marenco, Javier del Pino-Montes, Alberto Alonso, Carlos Rodríguez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Crespo" ] 1 => array:2 [ "nombre" => "Max" "apellidos" => "Brosa" ] 2 => array:2 [ "nombre" => "Jordi" "apellidos" => "Galván" ] 3 => array:2 [ "nombre" => "Jordi" "apellidos" => "Carbonell" ] 4 => array:2 [ "nombre" => "Jordi" "apellidos" => "Maymó" ] 5 => array:3 [ "Iniciales" => "J.L." "nombre" => "José Luis" "apellidos" => "Marenco" ] 6 => array:2 [ "nombre" => "Javier" "apellidos" => "del Pino-Montes" ] 7 => array:2 [ "nombre" => "Alberto" "apellidos" => "Alonso" ] 8 => array:2 [ "nombre" => "Carlos" "apellidos" => "Rodríguez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X10000495?idApp=UINPBA00004M" "url" => "/1699258X/0000000600000004/v1_201305061831/S1699258X10000495/v1_201305061831/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Juvenile Systemic Lupus Erythematosus associated with Klinefelter's syndrome: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "212" "paginaFinal" => "213" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Reza Shiari, Shirin Farivar" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Reza" "apellidos" => "Shiari" "email" => array:1 [ 0 => "shiareza@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Shirin" "apellidos" => "Farivar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pediatric Rheumatology, Department of Pediatrics, Mofid Children's Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Division of Genetics, Faculty of Biological Science, Shahid Beheshti University, G.C., Tehran, Iran" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lupus eritematoso sistémico de inicio juvenil asociado con el síndrome de klinefelter: un informe de casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1633 "Tamanyo" => 110211 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Ten metaphase spreads from bone marrow sample and 15 metaphase spreads from peripheral blood sample were studied on the basis of GCG technique at 400–450 band resolution, revealing 47-XXY pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara elsevierViewall">Klinefelter's syndrome is the most frequent major abnormality of sexual differentiation in men and affects one in every 500–1000 born males.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> Men with Klinefelter's syndrome have more than one X chromosomes, usually two X chromosomes (47-XXY). The phenotype is characterized by eunuchoid appearance, increased length of legs and arms, scanty facial and body hair, gynecomastia, small and firm testes, and hyperpigmentation of the lower extremities.<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> Hormonally, the syndrome is characterized by hypergonadotropic hypogonadism in which testosterone level is usually half of normal.<a class="elsevierStyleCrossRefs" href="#bib2"><span class="elsevierStyleSup">2,3</span></a> Patients with Klinefelter's syndrome show a higher percent of Systemic Lupus Erythematosus (SLE) and other skin-related autoimmune diseases than the normal population. SLE may be a presenting symptom of Klinefelter's syndrome and may lead to diagnosis of the disease.<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> Here we present a case of juvenile Systemic Lupus Erythematosus with Klinefelter's syndrome and most probably the first report from Middle East.</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p class="elsevierStylePara elsevierViewall">A 14-year-old Iranian boy presented to our department with a 3-week history of arthritis on both of his wrists and ankles, accompanied by myalgia and photosensitivity. His physical examination revealed butterfly rash, palmar and plantar erythema, and some small ulcers on his legs. He had low head hair implantment, and hyperpigmentation on face. Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, and long extremities. The results of his laboratory investigations were as follows: white blood cell count 4.2×103/mm<span class="elsevierStyleSup">3</span> (neutrophils 72%, lymphocytes 24%, monocytes 4%), red blood cells count 424×104/mm<span class="elsevierStyleSup">3</span>, platelets count 140×103/mm<span class="elsevierStyleSup">3</span>, hemoglobin 11.3<span class="elsevierStyleHsp" style=""></span>g/dL, hematocrit 34.1%, erythrocyte sedimation rate 84<span class="elsevierStyleHsp" style=""></span>mm/h, aspartate amino transferase 37<span class="elsevierStyleHsp" style=""></span>U/L, alanine aminotransferase 31<span class="elsevierStyleHsp" style=""></span>U/L, lactate dehydrogenase 232<span class="elsevierStyleHsp" style=""></span>U/L, creatine kinase 67<span class="elsevierStyleHsp" style=""></span>U/L, aldolase 5.6<span class="elsevierStyleHsp" style=""></span>U/L, blood urea nitrogen 27<span class="elsevierStyleHsp" style=""></span>mg/dL, creatinine 0.9<span class="elsevierStyleHsp" style=""></span>mg/dL, total protein 7.4<span class="elsevierStyleHsp" style=""></span>g/dL, antinuclear antibody (positive > 1:160 homogeneous pattern), rheumatoid factors (positive +2), C-reactive protein (positive 17<span class="elsevierStyleHsp" style=""></span>mg/L), C3 54<span class="elsevierStyleHsp" style=""></span>mg/dL, C4 11<span class="elsevierStyleHsp" style=""></span>mg/dL, IgG 2210<span class="elsevierStyleHsp" style=""></span>mg/dL, IgM 220<span class="elsevierStyleHsp" style=""></span>mg/dL, IgA 191<span class="elsevierStyleHsp" style=""></span>mg/dL, and IgE 500<span class="elsevierStyleHsp" style=""></span>mg/dL. His urine analysis revealed proteinuria 750<span class="elsevierStyleHsp" style=""></span>mg/1000<span class="elsevierStyleHsp" style=""></span>ml of urine collection. Results of other blood tests were within normal limits or negative, including lupus anticoagulant, β2-glycoprotein, anticardiolipin IgG and IgM Abs, anti-RO, anti-LA, anti-SM Ab, P & C-ANCA, VDRL, TSH, FT4, anti-T microsomal, antithyroglobulin, cryoglobulins, hepatitis C antibodies, hepatitis B antigen, protein C activity, and protein S free. According to American College of Rheumatology criteria for SLE, he was diagnosed as having juvenile Systemic Lupus Erythematosus.<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> His renal biopsy showed mesangial glomerulitis (World Health Organization Class II).<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> On admission, his endocrinological work-up discovered luteinizing hormone (6.9<span class="elsevierStyleHsp" style=""></span>mIU/mL [normal range for men 1–6<span class="elsevierStyleHsp" style=""></span>mIU/mL]), follicle stimulating hormone (22<span class="elsevierStyleHsp" style=""></span>mIU/mL [normal range for men 1.4–15.4<span class="elsevierStyleHsp" style=""></span>mIU/mL]), and testosterone (0.2<span class="elsevierStyleHsp" style=""></span>ng/ mL [normal range for men 2.5–9<span class="elsevierStyleHsp" style=""></span>ng/mL]), which indicate hypergonadotropic hypogonadism. His Karyotyping revealed 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome (<a class="elsevierStyleCrossRef" href="#fig1">Fig. 1</a>). He was treated with oral prednisone, Azathioprine, and hydroxychloroquine sulfate. At the same time, the patient was given intra-muscular testosterone once monthly for 1 year. Blood tests were performed for follow-up of the immune state, which were all within normal limits.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara elsevierViewall">Klinefelter's syndrome can present at any age. In adult men, the diagnosis may be made during investigation for sterility, but, at puberty, eunuch body might be the hallmark. Children with Klinefelter's syndrome might be diagnosed because of learning difficulties or social problems. Klinefelter's syndrome and SLE occur together more often than would be expected by chance alone.<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a> Studies have shown a clear relationship between low levels of testosterone and high prevalence of ulceration in patients with Klinefelter's syndrome. Treatment with testosterone leads to improvement of leg ulcers in these patients.<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> Our patient showed both leg ulcers and low level of testosterone, whose leg ulcers were also reduced during subsequent therapy that included testosterone.</p><p class="elsevierStylePara elsevierViewall">Males with untreated hypogonadism, associated with significant gonadal failure and very low levels of testosterone, have an increased risk of developing rheumatoid/autoimmune diseases. In fact, testicular dysfunction predisposes to the development of rheumatoid/autoimmune diseases. These patients have an increased frequency of antinuclear antibody and anticardiolipin antibodies compared with other hypogonadotropic hypogonadic patients.<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> Although, our patient's sera were not positive for anticardiolipin antibodies, it was positive for antinuclear antibody (positive > 1:160 homogeneous pattern). SLE may be a presenting symptom of Klinefelter's syndrome and may lead to diagnosis of the disease. The first presentation of our patient was arthritis, myalgia, and photosensitivity. However, his follow-up revealed hypergonadotropic hypogonadism and his karyotype confirmed the diagnosis of Kelienfelter's syndrome.</p><p class="elsevierStylePara elsevierViewall">Humoral and cellular immunities are enhanced in Klinefelter's syndrome, as a result of testosterone deficiency and increased levels of estradiol, which enhance autoantibody production. Treatment with testosterone has also proved to suppress both cellular and humoral immunities in these patients.<a class="elsevierStyleCrossRefs" href="#bib9"><span class="elsevierStyleSup">9,10</span></a></p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStylePara elsevierViewall">The frequency of Klinefelter's syndrome is increased in men with SLE compared with its prevalence in men without SLE. Therefore Klinefelter's syndrome and SLE might be associated. Whereas Klinefelter's syndrome in children is often subclinical, the pediatric rheumatologists treating male children with lupus should be aware of Klinefelter's syndrome and provide them access to imperative medical management.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres125854" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113148" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125853" "titulo" => "Resúmen" ] 3 => array:2 [ "identificador" => "xpalclavsec113149" "titulo" => "Palabras clave" ] 4 => array:1 [ "titulo" => "Introduction" ] 5 => array:1 [ "titulo" => "Case report" ] 6 => array:1 [ "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "Conclusion" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-04-19" "fechaAceptado" => "2009-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113148" "palabras" => array:5 [ 0 => "(47-XXY)" 1 => "X chromosomes" 2 => "Systemic Lupus Erythematosus" 3 => "SLE" 4 => "Klinefelter's syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113149" "palabras" => array:5 [ 0 => "(47-XXY)" 1 => "Cromosomas X" 2 => "Lupus eritematoso sistémico" 3 => "LES" 4 => "Síndrome de Klinefelter" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">We present the first reported case of juvenile Systemic Lupus Erythematosus with Klinefelter's syndrome in a 14-year-old Iranian boy who had leg ulcers and arthritis. He had low level of testosterone accompanied with hypergonadotropic hypogonadism. This case emphasizes the importance of two X chromosomes as a risk factor for Systemic Lupus Erythematosus in women and men with Klinefelter's syndrome (47, XXY).</p>" ] "es" => array:2 [ "titulo" => "Resúmen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Presentamos el primer caso notificado de lupus eritematoso sistémico de inicio juvenil junto con un síndrome de Klinefelter en un niño iraní de 14 años de edad que presentaba úlceras en piernas y artritis. Presentaba valores reducidos de testosterona acompañados con hipogonadismo hipergonadotrópico. Este caso resalta la importancia de dos cromosomas X como factor de riesgo de lupus eritematoso sistémico en mujeres y hombres con el síndrome de Klinelfelter (47, XXY).</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1633 "Tamanyo" => 110211 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Ten metaphase spreads from bone marrow sample and 15 metaphase spreads from peripheral blood sample were studied on the basis of GCG technique at 400–450 band resolution, revealing 47-XXY pattern.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of Klinefelter's syndrome (47, XXY) in a general population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Zeuthen" 1 => "J. Nielsen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Genet Hum" "fecha" => "1978" "volumen" => "26" "paginaInicial" => "85" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/670939" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650850701147X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syndrome characterized by gynecomastia, aspermatogenesis without aleydigism and increased excretion of follicle-stimulating hormone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.F. Klinefelter" 1 => "E.C. Reifenstein" 2 => "F. Albright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Endocrinol" "fecha" => "1942" "volumen" => "2" "paginaInicial" => "615" "paginaFinal" => "627" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Klinefelter's syndrome in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Bojesen" 1 => "C.H. Gravholt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nat Cli Pract Urol" "fecha" => "2003" "volumen" => "56" "paginaInicial" => "192" "paginaFinal" => "204" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic lupus erythematosus associated with Klinefelter's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Stern" 1 => "J. Fishman" 2 => "H. Brusman" 3 => "H.G. Kunkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1977" "volumen" => "20" "paginaInicial" => "18" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/300022" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 1982 revised criteria for the classification of systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.M. Tan" 1 => "A.S. Cohen" 2 => "J.F. Fries" 3 => "A.T. Masi" 4 => "D.J. McShane" 5 => "N.F. Rothfield" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1982" "volumen" => "25" "paginaInicial" => "1271" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7138600" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Membranous lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. Austin" 1 => "G.G. Illei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "65" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15732291" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Klinefelter's (47, XXY) in Male Systemic Lupus Erythematosus Patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.H. Scofield" 1 => "G.R. Bruner" 2 => "B. Namju" 3 => "R.P. Kimberly" 4 => "G.R. Ramsey" 5 => "M. Petri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.23701" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "2511" "paginaFinal" => "2517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18668569" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report: testosterone treatment of systemic lupus erythematosus in a patient with Klinefelter's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.J. Olsen" 1 => "W.J. Kovacs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med Sci" "fecha" => "1995" "volumen" => "310" "paginaInicial" => "158" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7573120" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Study of autoimmunity in Klinefelter's syndrome and idiopathic hypogonadotropic hypogonadism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Oktenli" 1 => "A. Yesilova" 2 => "I.H. Kocar" 3 => "U. Musabak" 4 => "M. Ozata" 5 => "A. Inak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Immunol" "fecha" => "2002" "volumen" => "22" "paginaInicial" => "137" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12078855" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythropoietic effect of androgen on anemia associated with Klinefelter's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Mitsutani" 1 => "M. Kamio" 2 => "T. Kohriyama" 3 => "T. Ishibashi" 4 => "T. Saito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rinsho Ketsueki" "fecha" => "1988" "volumen" => "29" "paginaInicial" => "896" "paginaFinal" => "900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2458494" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000000600000004/v1_201305061831/S1699258X10000537/v1_201305061831/en/main.assets" "Apartado" => array:4 [ "identificador" => "33643" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000000600000004/v1_201305061831/S1699258X10000537/v1_201305061831/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X10000537?idApp=UINPBA00004M" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 6 | 11 |
| 2024 Octubre | 71 | 41 | 112 |
| 2024 Septiembre | 74 | 24 | 98 |
| 2024 Agosto | 90 | 42 | 132 |
| 2024 Julio | 71 | 26 | 97 |
| 2024 Junio | 81 | 41 | 122 |
| 2024 Mayo | 93 | 40 | 133 |
| 2024 Abril | 101 | 30 | 131 |
| 2024 Marzo | 71 | 42 | 113 |
| 2024 Febrero | 83 | 43 | 126 |
| 2024 Enero | 48 | 28 | 76 |
| 2023 Diciembre | 33 | 20 | 53 |
| 2023 Noviembre | 56 | 23 | 79 |
| 2023 Octubre | 55 | 43 | 98 |
| 2023 Septiembre | 95 | 43 | 138 |
| 2023 Agosto | 50 | 22 | 72 |
| 2023 Julio | 45 | 25 | 70 |
| 2023 Junio | 45 | 30 | 75 |
| 2023 Mayo | 44 | 27 | 71 |
| 2023 Abril | 36 | 20 | 56 |
| 2023 Marzo | 65 | 21 | 86 |
| 2023 Febrero | 57 | 39 | 96 |
| 2023 Enero | 46 | 21 | 67 |
| 2022 Diciembre | 69 | 28 | 97 |
| 2022 Noviembre | 66 | 42 | 108 |
| 2022 Octubre | 66 | 47 | 113 |
| 2022 Septiembre | 79 | 36 | 115 |
| 2022 Agosto | 84 | 77 | 161 |
| 2022 Julio | 65 | 62 | 127 |
| 2022 Junio | 66 | 50 | 116 |
| 2022 Mayo | 120 | 52 | 172 |
| 2022 Abril | 75 | 53 | 128 |
| 2022 Marzo | 86 | 42 | 128 |
| 2022 Febrero | 77 | 38 | 115 |
| 2022 Enero | 63 | 43 | 106 |
| 2021 Diciembre | 58 | 50 | 108 |
| 2021 Noviembre | 63 | 41 | 104 |
| 2021 Octubre | 144 | 49 | 193 |
| 2021 Septiembre | 79 | 47 | 126 |
| 2021 Agosto | 52 | 54 | 106 |
| 2021 Julio | 41 | 51 | 92 |
| 2021 Junio | 53 | 58 | 111 |
| 2021 Mayo | 64 | 42 | 106 |
| 2021 Abril | 175 | 148 | 323 |
| 2021 Marzo | 116 | 45 | 161 |
| 2021 Febrero | 122 | 39 | 161 |
| 2021 Enero | 93 | 27 | 120 |
| 2020 Diciembre | 82 | 27 | 109 |
| 2020 Noviembre | 95 | 22 | 117 |
| 2020 Octubre | 63 | 29 | 92 |
| 2020 Septiembre | 77 | 36 | 113 |
| 2020 Agosto | 93 | 18 | 111 |
| 2020 Julio | 140 | 23 | 163 |
| 2020 Junio | 122 | 37 | 159 |
| 2020 Mayo | 108 | 27 | 135 |
| 2020 Abril | 58 | 20 | 78 |
| 2020 Marzo | 66 | 20 | 86 |
| 2020 Febrero | 69 | 22 | 91 |
| 2020 Enero | 47 | 27 | 74 |
| 2019 Diciembre | 63 | 31 | 94 |
| 2019 Noviembre | 39 | 24 | 63 |
| 2019 Octubre | 58 | 16 | 74 |
| 2019 Septiembre | 58 | 37 | 95 |
| 2019 Agosto | 56 | 36 | 92 |
| 2019 Julio | 88 | 24 | 112 |
| 2019 Junio | 101 | 34 | 135 |
| 2019 Mayo | 137 | 48 | 185 |
| 2019 Abril | 67 | 31 | 98 |
| 2019 Marzo | 58 | 30 | 88 |
| 2019 Febrero | 66 | 29 | 95 |
| 2019 Enero | 60 | 29 | 89 |
| 2018 Diciembre | 99 | 65 | 164 |
| 2018 Noviembre | 94 | 15 | 109 |
| 2018 Octubre | 79 | 9 | 88 |
| 2018 Septiembre | 43 | 6 | 49 |
| 2018 Agosto | 36 | 13 | 49 |
| 2018 Julio | 25 | 6 | 31 |
| 2018 Mayo | 5 | 0 | 5 |
| 2018 Abril | 43 | 4 | 47 |
| 2018 Marzo | 82 | 10 | 92 |
| 2018 Febrero | 43 | 5 | 48 |
| 2018 Enero | 44 | 4 | 48 |
| 2017 Diciembre | 53 | 11 | 64 |
| 2017 Noviembre | 39 | 12 | 51 |
| 2017 Octubre | 56 | 10 | 66 |
| 2017 Septiembre | 37 | 6 | 43 |
| 2017 Agosto | 35 | 7 | 42 |
| 2017 Julio | 40 | 11 | 51 |
| 2017 Junio | 55 | 13 | 68 |
| 2017 Mayo | 61 | 21 | 82 |
| 2017 Abril | 54 | 9 | 63 |
| 2017 Marzo | 54 | 45 | 99 |
| 2017 Febrero | 43 | 6 | 49 |
| 2017 Enero | 47 | 12 | 59 |
| 2016 Diciembre | 66 | 23 | 89 |
| 2016 Noviembre | 61 | 10 | 71 |
| 2016 Octubre | 71 | 24 | 95 |
| 2016 Septiembre | 62 | 14 | 76 |
| 2016 Agosto | 14 | 7 | 21 |
| 2016 Julio | 12 | 17 | 29 |
| 2016 Abril | 1 | 0 | 1 |
| 2016 Marzo | 1 | 0 | 1 |
| 2016 Febrero | 3 | 0 | 3 |
| 2015 Diciembre | 3 | 10 | 13 |
| 2015 Noviembre | 1 | 14 | 15 |
| 2015 Octubre | 5 | 15 | 20 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Agosto | 3 | 8 | 11 |
| 2015 Julio | 34 | 8 | 42 |
| 2015 Junio | 42 | 5 | 47 |
| 2015 Mayo | 65 | 16 | 81 |
| 2015 Abril | 75 | 7 | 82 |
| 2015 Marzo | 48 | 5 | 53 |
| 2015 Febrero | 60 | 1 | 61 |
| 2015 Enero | 62 | 0 | 62 |
| 2014 Diciembre | 61 | 0 | 61 |
| 2014 Noviembre | 43 | 0 | 43 |
| 2014 Octubre | 53 | 0 | 53 |
| 2014 Septiembre | 53 | 0 | 53 |
| 2014 Agosto | 43 | 0 | 43 |
| 2014 Julio | 49 | 0 | 49 |
| 2014 Junio | 70 | 0 | 70 |
| 2014 Mayo | 61 | 1 | 62 |
| 2014 Abril | 59 | 0 | 59 |
| 2014 Marzo | 66 | 8 | 74 |
| 2014 Febrero | 51 | 16 | 67 |
| 2014 Enero | 53 | 10 | 63 |
| 2013 Diciembre | 54 | 7 | 61 |
| 2013 Noviembre | 39 | 3 | 42 |
| 2013 Octubre | 64 | 8 | 72 |
| 2013 Septiembre | 49 | 10 | 59 |
| 2013 Agosto | 48 | 9 | 57 |
| 2013 Julio | 41 | 6 | 47 |
| 2013 Junio | 50 | 8 | 58 |
| 2013 Mayo | 39 | 4 | 43 |
| 2013 Abril | 37 | 5 | 42 |
| 2013 Marzo | 48 | 8 | 56 |
| 2013 Febrero | 43 | 3 | 46 |
| 2013 Enero | 44 | 5 | 49 |
| 2012 Diciembre | 25 | 6 | 31 |
| 2012 Noviembre | 18 | 8 | 26 |
| 2012 Octubre | 10 | 4 | 14 |
| 2012 Septiembre | 9 | 4 | 13 |
| 2011 Mayo | 2 | 0 | 2 |
| 2011 Abril | 4 | 0 | 4 |
| 2011 Marzo | 3 | 0 | 3 |
| 2011 Febrero | 7 | 0 | 7 |
| 2011 Enero | 5 | 0 | 5 |
| 2010 Diciembre | 4 | 0 | 4 |
| 2010 Noviembre | 8 | 0 | 8 |
| 2010 Octubre | 7 | 0 | 7 |
| 2010 Septiembre | 9 | 0 | 9 |
| 2010 Agosto | 3 | 0 | 3 |
| 2010 Julio | 15 | 0 | 15 |
| 2010 Junio | 4 | 0 | 4 |
Mostrar todo
