array:23 [
  "pii" => "S1699258X16301528"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2016.10.008"
  "estado" => "S300"
  "fechaPublicacion" => "2018-05-01"
  "aid" => "983"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2018;14:168-70"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2401
    "formatos" => array:3 [
      "EPUB" => 132
      "HTML" => 1384
      "PDF" => 885
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1699258X1630170X"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2016.12.005"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "1001"
    "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2018;14:171-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1670
      "formatos" => array:3 [
        "EPUB" => 149
        "HTML" => 925
        "PDF" => 596
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
      "titulo" => "Idoneidad de la punci&#243;n guiada por ecograf&#237;a de alta resoluci&#243;n en el diagn&#243;stico de una tumoraci&#243;n de partes blandas infectada por <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "171"
          "paginaFinal" => "172"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Suitability of High-resolution Ultrasound-guided Puncture in the Diagnosis of a Soft Tissue Mass Infected With <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 465
              "Ancho" => 2000
              "Tamanyo" => 115547
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#41; Imagen del compartimento dorsal de la mu&#241;eca derecha&#46; Distorsi&#243;n de la arquitectura de los compartimentos extensores&#46; Presencia de una gran masa de partes blandas que deforma el recorrido de los extensores comunes&#44; del extensor del quinto dedo y del extensor cubital&#46; B&#41; Imagen en corte longitudinal&#44; y C&#41; Transversal del tend&#243;n extensor com&#250;n de los dedos a nivel de la mu&#241;eca&#46; Incremento de neo-vascularizaci&#243;n con se&#241;al color Doppler evidente &#40;G3&#41; de actividad sobre el tend&#243;n extensor e infiltraci&#243;n de material infeccioso alrededor&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#232;ctor Corominas, D&#232;lia Reina, Vicen&#231; Torrente-Segarra, Cristina Chico, Vanessa Ant&#243;n, Paula Estrada, Vanessa Navarro"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "H&#232;ctor"
              "apellidos" => "Corominas"
            ]
            1 => array:2 [
              "nombre" => "D&#232;lia"
              "apellidos" => "Reina"
            ]
            2 => array:2 [
              "nombre" => "Vicen&#231;"
              "apellidos" => "Torrente-Segarra"
            ]
            3 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Chico"
            ]
            4 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Ant&#243;n"
            ]
            5 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Estrada"
            ]
            6 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Navarro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574318300303"
        "doi" => "10.1016/j.reumae.2016.12.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300303?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1630170X?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X1630170X/v1_201804190420/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1699258X16301577"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2016.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "988"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2018;14:164-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3504
      "formatos" => array:3 [
        "EPUB" => 157
        "HTML" => 2524
        "PDF" => 823
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Dacrioadenitis por enfermedad relacionada con IgG4 en una adolescente afrodescendiente de Colombia"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "164"
          "paginaFinal" => "167"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Dacryoadenitis associated with IgG4-related disease in an Afro-Colombian adolescent"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1468
              "Ancho" => 1500
              "Tamanyo" => 216698
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#41; Proptosis derecha al inicio del cuadro cl&#237;nico&#46; B&#41; RMN&#44; corte transversal&#44; al ingreso&#44; T1 poscontraste&#46; N&#243;tese el agrandamiento de la gl&#225;ndula lacrimal derecha&#44; con realce despu&#233;s de la administraci&#243;n del medio de contraste&#46; C&#41; Disminuci&#243;n de la proptosis despu&#233;s de un a&#241;o de seguimiento&#46; D&#41; RMN&#44; corte transversal&#44; de control al a&#241;o de seguimiento&#44; T1 poscontraste&#46; N&#243;tese la disminuci&#243;n del tama&#241;o de la gl&#225;ndula lacrimal derecha comparada con la RMN inicial&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gabriel Sebasti&#225;n D&#237;az-Ram&#237;rez, Luis Fernando Medina-Quintero, Alexander Salinas-C&#233;sar, Andr&#233;s Felipe Zea-Vera"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Gabriel Sebasti&#225;n"
              "apellidos" => "D&#237;az-Ram&#237;rez"
            ]
            1 => array:2 [
              "nombre" => "Luis Fernando"
              "apellidos" => "Medina-Quintero"
            ]
            2 => array:2 [
              "nombre" => "Alexander"
              "apellidos" => "Salinas-C&#233;sar"
            ]
            3 => array:2 [
              "nombre" => "Andr&#233;s Felipe"
              "apellidos" => "Zea-Vera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574318300194"
        "doi" => "10.1016/j.reumae.2016.11.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300194?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301577?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X16301577/v1_201804190420/es/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis &#8211; Case report"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "168"
        "paginaFinal" => "170"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Diana Rosa-Gon&#231;alves, Miguel Bernardes, L&#250;cia Costa"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Diana"
            "apellidos" => "Rosa-Gon&#231;alves"
            "email" => array:1 [
              0 => "di9&#95;goncalves&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Miguel"
            "apellidos" => "Bernardes"
          ]
          2 => array:2 [
            "nombre" => "L&#250;cia"
            "apellidos" => "Costa"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Rheumatology Department&#44; Centro Hospitalar S&#227;o Jo&#227;o&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Fascitis necrosante en un paciente bajo tocilizumab para la artritis reumatoide&#46; Presentaci&#243;n de un caso"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 832
            "Ancho" => 1500
            "Tamanyo" => 123152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolution of skin lesions at first five days of internment&#58; &#225;reas of extensive skin detachment in the context of ruptura of blisters and severe exudation and necrotic &#225;reas&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Necrotizing fasciitis &#40;NF&#41; is a rare severe infection affecting subcutaneous tissue and superficial fascia associated with considerable mortality &#40;70&#8211;80&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a> The infections are the most feared adverse events of tocilizumab &#40;TOC&#41;&#59; there are few published pos-marketing data&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A case report of NF is presented with a published cases review through PubMed database and several European Biologics Registers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 66-year-old Caucasian woman with a seropositive RA presented with sudden onset of severe and progressive forearm and elbow pain with 3 days of evolution&#46; She denied fever and history of trauma or animal bite&#46; Since fourteen years ago&#44; she has been consecutively treated with methotrexate &#40;up to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#41;&#44; etanercept &#40;50<span class="elsevierStyleHsp" style=""></span>mg weekly&#41; and adalimumab &#40;40<span class="elsevierStyleHsp" style=""></span>mg fortnightly&#41;&#44; which were discontinued owing to lack of efficacy&#46; For three years&#44; she has been treated with prednisolone &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; leflunomide &#40;LEF&#41; &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; and TOC &#40;8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg intravenous &#40;iv&#41; every 4 weeks&#41;&#46; The prior medical history was significant for bacterial osteomyelitis &#40;foot fifth digit&#41; under TOC monotherapy for a year&#46; Vital signs were as follow&#58; pulse&#44; 86beats&#47;min&#59; blood pressure&#44; 135&#47;72<span class="elsevierStyleHsp" style=""></span>mmHg&#59; body temperature&#44; 36&#46;8<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Had active synovitis in metacarpophalangeal&#44; interphalangeal and wrist joints&#46; Left upper limb presented diffusely oedematous with a slight erythematous rash and increased temperature&#46; Laboratory tests were as follow&#58; hemoglobin 12&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#59; white blood cell &#40;WBC&#41; count 11&#46;8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l &#40;neutrophils 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l&#41;&#59; platelets 149<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l&#59; C-reactive protein &#40;CRP&#41; 74&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#59; creatinine 1&#46;51<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; sodium 138<span class="elsevierStyleHsp" style=""></span>mEq&#47;l and glucose 91<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Arteriovenous Doppler ultrasound excluded venous thrombosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Three days later&#44; erythrocyte sedimentation rate was 58<span class="elsevierStyleHsp" style=""></span>mm and CRP 188&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Differential diagnosis included cellulitis and septic arthritis&#46; Immunosuppressants drugs were discontinued&#44; cholestyramine and empiric antibiotic therapy &#40;vancomycin and imipenem&#41; were initiated&#46; Magnetic resonance showed peri-aponeurosis and muscle edema &#40;especially deltoid muscle&#41;&#44; signs of cellulitis&#44; without organized collections&#46; At day 5 of treatment&#44; lesions rapidly progressed to extensive areas of skin detachment and necrosis with severe exudation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She had now periodic fever&#46; <span class="elsevierStyleItalic">Enterobacter aerogenes</span>&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> and <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> were identified in the skin&#59; blood cultures were negative&#46; Surgical debridement with subsequent partial skin graft and a twenty-days period of antibiotics led to progressive improvement&#46; She was discharged at day 39&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After one-year follow-up there was no recurrence of infections&#46; She is under hydroxychloroquine &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; and prednisolone &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Methotrexate was added but soon discontinued due to oral mucositis&#46; TOC was permanently withdrawn&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Literature review and discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">We identified three case reports of NF in RA patients receiving TOC<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#8211;5</span></a> and three under TNF antagonists<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6&#8211;8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Published rates of serious skin and soft tissue infections in RA patients vary widely between different European Biologics Registers&#44; from 12&#8211;18 per 1000 patient-years in the British register to 37&#8211;76 per 1000 patient-years in German register&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Results from British register showed that the majority were cellulitis &#40;227&#47;309&#59; 73&#37;&#41; and only four cases were NF &#40;all with anti-TNF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A German cohort study concluded that longer disease duration&#44; history of severe infections&#44; previous exposure to multiple DMARDs and concomitant treatments with LEF&#44; prednisone or proton-pump inhibitor increase the risk of infections under TOC&#46; This is our patient profile&#46; In the TOWARD study&#44; infections were more prevalent among patients receiving TOC and DMARDs simultaneously&#59; however&#44; there was no explicitly assigned association to LEF&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Thus&#44; we cannot overlooked that our patient was under LEF and glucocorticoids and we should attribute the adverse event to their association with TOC rather than to TOC alone&#46; TOC contribution remains speculative and causality can neither be asserted nor ruled out with certainty&#46; So&#44; we believe that is important to report such infections in the post-marketing surveillance&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; physician should keep in mind that infections may mimic a disease flare and the absence of fever does not exclude serious infections in RA patients under biologics&#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 animals subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors state that no human or animal experiments have been performed for this investigation&#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 state 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 they have received written consent from the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence must be in possession of this document&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">All authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1016825"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec975627"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1016824"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec975626"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Literature review and discussion"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Protection of human and animals 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 interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-08-03"
    "fechaAceptado" => "2016-10-28"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec975627"
          "palabras" => array:6 [
            0 => "Rheumatoid arthritis"
            1 => "Infection"
            2 => "Necrotizing fasciitis"
            3 => "Skin"
            4 => "Tocilizumab"
            5 => "Tumor necrosis factor antagonists"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec975626"
          "palabras" => array:6 [
            0 => "Artritis reumatoide"
            1 => "Infecci&#243;n"
            2 => "Fascitis necrosante"
            3 => "Piel"
            4 => "Tocilizumab"
            5 => "Antagonistas del factor de necrosis tumoral alfa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab&#44; and provide a review of published cases&#46; The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation&#46; She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso de fascitis necrosante en una mujer cauc&#225;sica de 66 a&#241;os de edad con artritis reumatoide en tratamiento con tocilizumab y se ha realizado una revisi&#243;n de casos publicados&#46; La paciente ha presentado falta de s&#237;ntomas sist&#233;micos y se&#241;ales inflamatorias cut&#225;neas discretas&#46; Ha sido tratada con &#233;xito con terapia antibi&#243;tica emp&#237;rica de amplio espectro y desbridamiento quir&#250;rgico&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 832
            "Ancho" => 1500
            "Tamanyo" => 123152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolution of skin lesions at first five days of internment&#58; &#225;reas of extensive skin detachment in the context of ruptura of blisters and severe exudation and necrotic &#225;reas&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">AZA&#44; azathioprine&#59; cDMARD&#44; classic disease-modifying antirheumatic drugs&#59; CCT&#44; corticotherapy&#59; CRP&#44; C-reactive protein&#59; CT&#44; computerized tomography&#59; DIC&#44; disseminated intravascular coagulation&#59; DM&#44; diabetes mellitus&#59; F&#44; female&#59; HCQ&#44; hydroxychloroquine&#59; IVIG&#44; intravenous immunoglobulin&#59; LEFL&#44; leflunomide&#59; MRI&#44; magnetic resonance imaging&#59; M&#44; male&#59; MTX&#44; methotrexate&#59; RA&#44; rheumatoid arthritis&#59; SSZ&#44; sulfasalazine&#59; TCZ&#44; tocilizumab&#59; WBC&#44; white blood cell&#59; &#63;&#44; unknown&#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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RA duration &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TNF&#945; blockers&#47;TCZ therapy duration &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current cDMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AZA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">i&#46;m MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous DMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MTX&#44; HCQ&#44; adalimumab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MTX&#44; SSZ&#44; tracolimus&#44; infliximab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SSZ&#44; AZA&#44; cyclosporin&#44; i&#46;m&#46; gold&#44; MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gold&#44; HCQ&#44; SSZ&#44; MTX&#44; AZA&#44; LEFL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous infection under biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pectoral region<br>Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hand&#44; Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thigh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lower limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fever at apresentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WBC &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutrophils &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;669&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Raised&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Raised&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasciitis in CT&#47;MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Isolated agents in skin swabs&#47;blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus &#40;pyogenes&#41;&#47;None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;none&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;none&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;Group A Streptococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;Group A Streptococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gentamicin&#44; penicillin&#44; clindamycin&#44; &#40;&#43;IVIGs<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>hydrocortisone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penicillin G&#44; meropenem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cefotaxime&#44; metronidazol&#44; vancomycin&#44; ciprofloxacin&#59; clindamycin&#44; ciprofloxacin&#44; flucloxacillin&#44; benzylpenicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DIC treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamicina&#44; vancomicina&#44; levofloxacina&#44; IVIGs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical debridement&#47;skin graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis&#47;death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes &#40;DIC&#41;&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1723935.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Characterization of reported cases of necrotizing fasciitis with tocilizumab and TNF&#945; blockers&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical safety of tocilizumab in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Bannwarth"
                            1 => "C&#46; Richez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1517/14740338.2011.537256"
                      "Revista" => array:7 [
                        "tituloSerie" => "Expert Opin Drug Saf"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "123"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21121872"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001502820001699X"
                          "estado" => "S300"
                          "issn" => "00150282"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of adverse events including serious infections in rheumatoid arthritis patients treated with tocilizumab&#58; a systematic literature review and meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Campbell"
                            1 => "C&#46; Chen"
                            2 => "S&#46;S&#46; Bhagat"
                            3 => "R&#46;A&#46; Parker"
                            4 => "A&#46;J&#46; &#214;st&#246;r"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "552"
                        "paginaFinal" => "562"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing fasciitis in a patient with rheumatoid arthritis treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Yoshida"
                            1 => "T&#46; Ota"
                            2 => "S&#46; Sasaoka"
                            3 => "H&#46; Matsuura"
                            4 => "W&#46; Fujimoto"
                            5 => "Y&#46; Morita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10165-011-0505-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mod Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "22"
                        "paginaInicial" => "317"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21830046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing fasciitis in a rheumatoid arthritis patient treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;G&#46; van de Sande"
                            1 => "E&#46;R&#46; van Slobbe-Bijlsma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/ker336"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "577"
                        "paginaFinal" => "578"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22096010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of necrotising fasciitis in a patient treated for rheumatoid arthritis with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Hashimoto"
                            1 => "T&#46; Yamaoka"
                            2 => "H&#46; Koguchi-Yoshioka"
                            3 => "A&#46; Tanaka"
                            4 => "A&#46; Tanemura"
                            5 => "H&#46; Azukizawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-1952"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2015"
                        "volumen" => "95"
                        "paginaInicial" => "370"
                        "paginaFinal" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25138684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Smyth"
                            1 => "D&#46;D&#46; Houlihan"
                            2 => "H&#46; Tuite"
                            3 => "C&#46; Fleming"
                            4 => "T&#46;A&#46; O&#8217;Gorman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Case Rep"
                        "fecha" => "2010"
                        "volumen" => "4"
                        "paginaInicial" => "367"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937813002639"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotising fasciitis in a patient receiving infliximab for rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Chan"
                            1 => "V&#46; Cleeve"
                            2 => "T&#46;J&#46; Daymond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med J"
                        "fecha" => "2002"
                        "volumen" => "78"
                        "paginaInicial" => "47"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11796874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Baghai"
                            1 => "D&#46;R&#46; Osmon"
                            2 => "D&#46;M&#46; Wolk"
                            3 => "L&#46;E&#46; Wold"
                            4 => "G&#46;J&#46; Haidukewych"
                            5 => "E&#46;L&#46; Matteson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/76.6.653"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2001"
                        "volumen" => "76"
                        "paginaInicial" => "653"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11393506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous adverse events during treatment of chronic inflammatory rheumatic conditions with tumor necrosis factor antagonists&#58; study using the Spanish registry of adverse events of biological therapies in rheumatic diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Hern&#225;ndez MV1"
                            1 => "R&#46; Sanmart&#237;"
                            2 => "J&#46;D&#46; Ca&#241;ete"
                            3 => "M&#46;A&#46; Descalzo"
                            4 => "M&#46; Alsina"
                            5 => "L&#46; Carmona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2013"
                        "volumen" => "65"
                        "paginaInicial" => "2024"
                        "paginaFinal" => "2031"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of skin and soft tissue infections &#40;including shingles&#41; in patients exposed to anti-tumour necrosis factor therapy&#58; results from the British Society for Rheumatology Biologics Register"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Galloway"
                            1 => "L&#46;K&#46; Mercer"
                            2 => "A&#46; Moseley"
                            3 => "W&#46;G&#46; Dixon"
                            4 => "A&#46;P&#46; Ustianowski"
                            5 => "M&#46; Helbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-201108"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
                        "volumen" => "72"
                        "paginaInicial" => "229"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of infections in rheumatoid arthritis patients treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;R&#46; Lang"
                            1 => "M&#46; Englbrecht"
                            2 => "J&#46; Rech"
                            3 => "H&#46; N&#252;sslein"
                            4 => "K&#46; Manger"
                            5 => "F&#46; Schuch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "852"
                        "paginaFinal" => "857"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X16301528/v1_201804190420/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "46460"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Caso cl&#237;nico"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001400000003/v1_201804190420/S1699258X16301528/v1_201804190420/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301528?idApp=UINPBA00004M"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case report
Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis – Case report
Fascitis necrosante en un paciente bajo tocilizumab para la artritis reumatoide. Presentación de un caso
Diana Rosa-Gonçalves
Autor para correspondencia
di9_goncalves@hotmail.com

Corresponding author.
, Miguel Bernardes, Lúcia Costa
Rheumatology Department, Centro Hospitalar São João, Portugal
Leído
8461
Veces
se ha leído el artículo
3066
Total PDF
5395
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S1699258X16301528"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2016.10.008"
  "estado" => "S300"
  "fechaPublicacion" => "2018-05-01"
  "aid" => "983"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Reumatol Clin. 2018;14:168-70"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2401
    "formatos" => array:3 [
      "EPUB" => 132
      "HTML" => 1384
      "PDF" => 885
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1699258X1630170X"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2016.12.005"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "1001"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2018;14:171-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1670
      "formatos" => array:3 [
        "EPUB" => 149
        "HTML" => 925
        "PDF" => 596
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
      "titulo" => "Idoneidad de la punci&#243;n guiada por ecograf&#237;a de alta resoluci&#243;n en el diagn&#243;stico de una tumoraci&#243;n de partes blandas infectada por <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "171"
          "paginaFinal" => "172"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Suitability of High-resolution Ultrasound-guided Puncture in the Diagnosis of a Soft Tissue Mass Infected With <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 465
              "Ancho" => 2000
              "Tamanyo" => 115547
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#41; Imagen del compartimento dorsal de la mu&#241;eca derecha&#46; Distorsi&#243;n de la arquitectura de los compartimentos extensores&#46; Presencia de una gran masa de partes blandas que deforma el recorrido de los extensores comunes&#44; del extensor del quinto dedo y del extensor cubital&#46; B&#41; Imagen en corte longitudinal&#44; y C&#41; Transversal del tend&#243;n extensor com&#250;n de los dedos a nivel de la mu&#241;eca&#46; Incremento de neo-vascularizaci&#243;n con se&#241;al color Doppler evidente &#40;G3&#41; de actividad sobre el tend&#243;n extensor e infiltraci&#243;n de material infeccioso alrededor&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#232;ctor Corominas, D&#232;lia Reina, Vicen&#231; Torrente-Segarra, Cristina Chico, Vanessa Ant&#243;n, Paula Estrada, Vanessa Navarro"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "H&#232;ctor"
              "apellidos" => "Corominas"
            ]
            1 => array:2 [
              "nombre" => "D&#232;lia"
              "apellidos" => "Reina"
            ]
            2 => array:2 [
              "nombre" => "Vicen&#231;"
              "apellidos" => "Torrente-Segarra"
            ]
            3 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Chico"
            ]
            4 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Ant&#243;n"
            ]
            5 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Estrada"
            ]
            6 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Navarro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574318300303"
        "doi" => "10.1016/j.reumae.2016.12.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300303?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1630170X?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X1630170X/v1_201804190420/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1699258X16301577"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2016.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "988"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2018;14:164-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3504
      "formatos" => array:3 [
        "EPUB" => 157
        "HTML" => 2524
        "PDF" => 823
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Dacrioadenitis por enfermedad relacionada con IgG4 en una adolescente afrodescendiente de Colombia"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "164"
          "paginaFinal" => "167"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Dacryoadenitis associated with IgG4-related disease in an Afro-Colombian adolescent"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1468
              "Ancho" => 1500
              "Tamanyo" => 216698
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#41; Proptosis derecha al inicio del cuadro cl&#237;nico&#46; B&#41; RMN&#44; corte transversal&#44; al ingreso&#44; T1 poscontraste&#46; N&#243;tese el agrandamiento de la gl&#225;ndula lacrimal derecha&#44; con realce despu&#233;s de la administraci&#243;n del medio de contraste&#46; C&#41; Disminuci&#243;n de la proptosis despu&#233;s de un a&#241;o de seguimiento&#46; D&#41; RMN&#44; corte transversal&#44; de control al a&#241;o de seguimiento&#44; T1 poscontraste&#46; N&#243;tese la disminuci&#243;n del tama&#241;o de la gl&#225;ndula lacrimal derecha comparada con la RMN inicial&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gabriel Sebasti&#225;n D&#237;az-Ram&#237;rez, Luis Fernando Medina-Quintero, Alexander Salinas-C&#233;sar, Andr&#233;s Felipe Zea-Vera"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Gabriel Sebasti&#225;n"
              "apellidos" => "D&#237;az-Ram&#237;rez"
            ]
            1 => array:2 [
              "nombre" => "Luis Fernando"
              "apellidos" => "Medina-Quintero"
            ]
            2 => array:2 [
              "nombre" => "Alexander"
              "apellidos" => "Salinas-C&#233;sar"
            ]
            3 => array:2 [
              "nombre" => "Andr&#233;s Felipe"
              "apellidos" => "Zea-Vera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173574318300194"
        "doi" => "10.1016/j.reumae.2016.11.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300194?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301577?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X16301577/v1_201804190420/es/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis &#8211; Case report"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "168"
        "paginaFinal" => "170"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Diana Rosa-Gon&#231;alves, Miguel Bernardes, L&#250;cia Costa"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Diana"
            "apellidos" => "Rosa-Gon&#231;alves"
            "email" => array:1 [
              0 => "di9&#95;goncalves&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Miguel"
            "apellidos" => "Bernardes"
          ]
          2 => array:2 [
            "nombre" => "L&#250;cia"
            "apellidos" => "Costa"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Rheumatology Department&#44; Centro Hospitalar S&#227;o Jo&#227;o&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Fascitis necrosante en un paciente bajo tocilizumab para la artritis reumatoide&#46; Presentaci&#243;n de un caso"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 832
            "Ancho" => 1500
            "Tamanyo" => 123152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolution of skin lesions at first five days of internment&#58; &#225;reas of extensive skin detachment in the context of ruptura of blisters and severe exudation and necrotic &#225;reas&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Necrotizing fasciitis &#40;NF&#41; is a rare severe infection affecting subcutaneous tissue and superficial fascia associated with considerable mortality &#40;70&#8211;80&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a> The infections are the most feared adverse events of tocilizumab &#40;TOC&#41;&#59; there are few published pos-marketing data&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A case report of NF is presented with a published cases review through PubMed database and several European Biologics Registers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 66-year-old Caucasian woman with a seropositive RA presented with sudden onset of severe and progressive forearm and elbow pain with 3 days of evolution&#46; She denied fever and history of trauma or animal bite&#46; Since fourteen years ago&#44; she has been consecutively treated with methotrexate &#40;up to 20<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#41;&#44; etanercept &#40;50<span class="elsevierStyleHsp" style=""></span>mg weekly&#41; and adalimumab &#40;40<span class="elsevierStyleHsp" style=""></span>mg fortnightly&#41;&#44; which were discontinued owing to lack of efficacy&#46; For three years&#44; she has been treated with prednisolone &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; leflunomide &#40;LEF&#41; &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; and TOC &#40;8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg intravenous &#40;iv&#41; every 4 weeks&#41;&#46; The prior medical history was significant for bacterial osteomyelitis &#40;foot fifth digit&#41; under TOC monotherapy for a year&#46; Vital signs were as follow&#58; pulse&#44; 86beats&#47;min&#59; blood pressure&#44; 135&#47;72<span class="elsevierStyleHsp" style=""></span>mmHg&#59; body temperature&#44; 36&#46;8<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Had active synovitis in metacarpophalangeal&#44; interphalangeal and wrist joints&#46; Left upper limb presented diffusely oedematous with a slight erythematous rash and increased temperature&#46; Laboratory tests were as follow&#58; hemoglobin 12&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#59; white blood cell &#40;WBC&#41; count 11&#46;8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l &#40;neutrophils 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l&#41;&#59; platelets 149<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>109&#47;l&#59; C-reactive protein &#40;CRP&#41; 74&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#59; creatinine 1&#46;51<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; sodium 138<span class="elsevierStyleHsp" style=""></span>mEq&#47;l and glucose 91<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Arteriovenous Doppler ultrasound excluded venous thrombosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Three days later&#44; erythrocyte sedimentation rate was 58<span class="elsevierStyleHsp" style=""></span>mm and CRP 188&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; Differential diagnosis included cellulitis and septic arthritis&#46; Immunosuppressants drugs were discontinued&#44; cholestyramine and empiric antibiotic therapy &#40;vancomycin and imipenem&#41; were initiated&#46; Magnetic resonance showed peri-aponeurosis and muscle edema &#40;especially deltoid muscle&#41;&#44; signs of cellulitis&#44; without organized collections&#46; At day 5 of treatment&#44; lesions rapidly progressed to extensive areas of skin detachment and necrosis with severe exudation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She had now periodic fever&#46; <span class="elsevierStyleItalic">Enterobacter aerogenes</span>&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> and <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> were identified in the skin&#59; blood cultures were negative&#46; Surgical debridement with subsequent partial skin graft and a twenty-days period of antibiotics led to progressive improvement&#46; She was discharged at day 39&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After one-year follow-up there was no recurrence of infections&#46; She is under hydroxychloroquine &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; and prednisolone &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; Methotrexate was added but soon discontinued due to oral mucositis&#46; TOC was permanently withdrawn&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Literature review and discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">We identified three case reports of NF in RA patients receiving TOC<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#8211;5</span></a> and three under TNF antagonists<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6&#8211;8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Published rates of serious skin and soft tissue infections in RA patients vary widely between different European Biologics Registers&#44; from 12&#8211;18 per 1000 patient-years in the British register to 37&#8211;76 per 1000 patient-years in German register&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Results from British register showed that the majority were cellulitis &#40;227&#47;309&#59; 73&#37;&#41; and only four cases were NF &#40;all with anti-TNF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A German cohort study concluded that longer disease duration&#44; history of severe infections&#44; previous exposure to multiple DMARDs and concomitant treatments with LEF&#44; prednisone or proton-pump inhibitor increase the risk of infections under TOC&#46; This is our patient profile&#46; In the TOWARD study&#44; infections were more prevalent among patients receiving TOC and DMARDs simultaneously&#59; however&#44; there was no explicitly assigned association to LEF&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Thus&#44; we cannot overlooked that our patient was under LEF and glucocorticoids and we should attribute the adverse event to their association with TOC rather than to TOC alone&#46; TOC contribution remains speculative and causality can neither be asserted nor ruled out with certainty&#46; So&#44; we believe that is important to report such infections in the post-marketing surveillance&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; physician should keep in mind that infections may mimic a disease flare and the absence of fever does not exclude serious infections in RA patients under biologics&#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 animals subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors state that no human or animal experiments have been performed for this investigation&#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 state 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 they have received written consent from the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence must be in possession of this document&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">All authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1016825"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec975627"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1016824"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec975626"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Literature review and discussion"
        ]
        7 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Protection of human and animals 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 interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-08-03"
    "fechaAceptado" => "2016-10-28"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec975627"
          "palabras" => array:6 [
            0 => "Rheumatoid arthritis"
            1 => "Infection"
            2 => "Necrotizing fasciitis"
            3 => "Skin"
            4 => "Tocilizumab"
            5 => "Tumor necrosis factor antagonists"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec975626"
          "palabras" => array:6 [
            0 => "Artritis reumatoide"
            1 => "Infecci&#243;n"
            2 => "Fascitis necrosante"
            3 => "Piel"
            4 => "Tocilizumab"
            5 => "Antagonistas del factor de necrosis tumoral alfa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab&#44; and provide a review of published cases&#46; The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation&#46; She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso de fascitis necrosante en una mujer cauc&#225;sica de 66 a&#241;os de edad con artritis reumatoide en tratamiento con tocilizumab y se ha realizado una revisi&#243;n de casos publicados&#46; La paciente ha presentado falta de s&#237;ntomas sist&#233;micos y se&#241;ales inflamatorias cut&#225;neas discretas&#46; Ha sido tratada con &#233;xito con terapia antibi&#243;tica emp&#237;rica de amplio espectro y desbridamiento quir&#250;rgico&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 832
            "Ancho" => 1500
            "Tamanyo" => 123152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolution of skin lesions at first five days of internment&#58; &#225;reas of extensive skin detachment in the context of ruptura of blisters and severe exudation and necrotic &#225;reas&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">AZA&#44; azathioprine&#59; cDMARD&#44; classic disease-modifying antirheumatic drugs&#59; CCT&#44; corticotherapy&#59; CRP&#44; C-reactive protein&#59; CT&#44; computerized tomography&#59; DIC&#44; disseminated intravascular coagulation&#59; DM&#44; diabetes mellitus&#59; F&#44; female&#59; HCQ&#44; hydroxychloroquine&#59; IVIG&#44; intravenous immunoglobulin&#59; LEFL&#44; leflunomide&#59; MRI&#44; magnetic resonance imaging&#59; M&#44; male&#59; MTX&#44; methotrexate&#59; RA&#44; rheumatoid arthritis&#59; SSZ&#44; sulfasalazine&#59; TCZ&#44; tocilizumab&#59; WBC&#44; white blood cell&#59; &#63;&#44; unknown&#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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Case &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TCZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RA duration &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TNF&#945; blockers&#47;TCZ therapy duration &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current cDMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AZA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">i&#46;m MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous DMARD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MTX&#44; HCQ&#44; adalimumab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MTX&#44; SSZ&#44; tracolimus&#44; infliximab&#44; etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SSZ&#44; AZA&#44; cyclosporin&#44; i&#46;m&#46; gold&#44; MTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gold&#44; HCQ&#44; SSZ&#44; MTX&#44; AZA&#44; LEFL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous infection under biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pectoral region<br>Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hand&#44; Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thigh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lower limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fever at apresentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WBC &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;820&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutrophils &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;669&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Raised&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;990&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Raised&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fasciitis in CT&#47;MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not done&#47;not done&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Isolated agents in skin swabs&#47;blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus &#40;pyogenes&#41;&#47;None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;none&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;none&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;Group A Streptococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group A Streptococcus&#47;Group A Streptococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gentamicin&#44; penicillin&#44; clindamycin&#44; &#40;&#43;IVIGs<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>hydrocortisone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penicillin G&#44; meropenem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cefotaxime&#44; metronidazol&#44; vancomycin&#44; ciprofloxacin&#59; clindamycin&#44; ciprofloxacin&#44; flucloxacillin&#44; benzylpenicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DIC treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clindamicina&#44; vancomicina&#44; levofloxacina&#44; IVIGs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical debridement&#47;skin graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis&#47;death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes &#40;DIC&#41;&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#47;yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1723935.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Characterization of reported cases of necrotizing fasciitis with tocilizumab and TNF&#945; blockers&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical safety of tocilizumab in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Bannwarth"
                            1 => "C&#46; Richez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1517/14740338.2011.537256"
                      "Revista" => array:7 [
                        "tituloSerie" => "Expert Opin Drug Saf"
                        "fecha" => "2011"
                        "volumen" => "10"
                        "paginaInicial" => "123"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21121872"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S001502820001699X"
                          "estado" => "S300"
                          "issn" => "00150282"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of adverse events including serious infections in rheumatoid arthritis patients treated with tocilizumab&#58; a systematic literature review and meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Campbell"
                            1 => "C&#46; Chen"
                            2 => "S&#46;S&#46; Bhagat"
                            3 => "R&#46;A&#46; Parker"
                            4 => "A&#46;J&#46; &#214;st&#246;r"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "552"
                        "paginaFinal" => "562"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing fasciitis in a patient with rheumatoid arthritis treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Yoshida"
                            1 => "T&#46; Ota"
                            2 => "S&#46; Sasaoka"
                            3 => "H&#46; Matsuura"
                            4 => "W&#46; Fujimoto"
                            5 => "Y&#46; Morita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10165-011-0505-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mod Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "22"
                        "paginaInicial" => "317"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21830046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing fasciitis in a rheumatoid arthritis patient treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;G&#46; van de Sande"
                            1 => "E&#46;R&#46; van Slobbe-Bijlsma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/ker336"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "577"
                        "paginaFinal" => "578"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22096010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of necrotising fasciitis in a patient treated for rheumatoid arthritis with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Hashimoto"
                            1 => "T&#46; Yamaoka"
                            2 => "H&#46; Koguchi-Yoshioka"
                            3 => "A&#46; Tanaka"
                            4 => "A&#46; Tanemura"
                            5 => "H&#46; Azukizawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-1952"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2015"
                        "volumen" => "95"
                        "paginaInicial" => "370"
                        "paginaFinal" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25138684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Smyth"
                            1 => "D&#46;D&#46; Houlihan"
                            2 => "H&#46; Tuite"
                            3 => "C&#46; Fleming"
                            4 => "T&#46;A&#46; O&#8217;Gorman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Case Rep"
                        "fecha" => "2010"
                        "volumen" => "4"
                        "paginaInicial" => "367"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937813002639"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotising fasciitis in a patient receiving infliximab for rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Chan"
                            1 => "V&#46; Cleeve"
                            2 => "T&#46;J&#46; Daymond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med J"
                        "fecha" => "2002"
                        "volumen" => "78"
                        "paginaInicial" => "47"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11796874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Baghai"
                            1 => "D&#46;R&#46; Osmon"
                            2 => "D&#46;M&#46; Wolk"
                            3 => "L&#46;E&#46; Wold"
                            4 => "G&#46;J&#46; Haidukewych"
                            5 => "E&#46;L&#46; Matteson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/76.6.653"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "2001"
                        "volumen" => "76"
                        "paginaInicial" => "653"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11393506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous adverse events during treatment of chronic inflammatory rheumatic conditions with tumor necrosis factor antagonists&#58; study using the Spanish registry of adverse events of biological therapies in rheumatic diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Hern&#225;ndez MV1"
                            1 => "R&#46; Sanmart&#237;"
                            2 => "J&#46;D&#46; Ca&#241;ete"
                            3 => "M&#46;A&#46; Descalzo"
                            4 => "M&#46; Alsina"
                            5 => "L&#46; Carmona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2013"
                        "volumen" => "65"
                        "paginaInicial" => "2024"
                        "paginaFinal" => "2031"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of skin and soft tissue infections &#40;including shingles&#41; in patients exposed to anti-tumour necrosis factor therapy&#58; results from the British Society for Rheumatology Biologics Register"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Galloway"
                            1 => "L&#46;K&#46; Mercer"
                            2 => "A&#46; Moseley"
                            3 => "W&#46;G&#46; Dixon"
                            4 => "A&#46;P&#46; Ustianowski"
                            5 => "M&#46; Helbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2011-201108"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2013"
                        "volumen" => "72"
                        "paginaInicial" => "229"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of infections in rheumatoid arthritis patients treated with tocilizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;R&#46; Lang"
                            1 => "M&#46; Englbrecht"
                            2 => "J&#46; Rech"
                            3 => "H&#46; N&#252;sslein"
                            4 => "K&#46; Manger"
                            5 => "F&#46; Schuch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "852"
                        "paginaFinal" => "857"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001400000003/v1_201804190420/S1699258X16301528/v1_201804190420/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "46460"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Caso cl&#237;nico"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001400000003/v1_201804190420/S1699258X16301528/v1_201804190420/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301528?idApp=UINPBA00004M"
]
Información del artículo
ISSN: 1699258X
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 4 3 7
2024 Octubre 53 21 74
2024 Septiembre 68 16 84
2024 Agosto 77 34 111
2024 Julio 69 26 95
2024 Junio 69 39 108
2024 Mayo 69 37 106
2024 Abril 86 37 123
2024 Marzo 67 37 104
2024 Febrero 53 25 78
2024 Enero 42 27 69
2023 Diciembre 39 36 75
2023 Noviembre 40 27 67
2023 Octubre 63 32 95
2023 Septiembre 65 38 103
2023 Agosto 47 6 53
2023 Julio 57 30 87
2023 Junio 53 29 82
2023 Mayo 58 28 86
2023 Abril 42 10 52
2023 Marzo 91 29 120
2023 Febrero 84 34 118
2023 Enero 57 33 90
2022 Diciembre 131 54 185
2022 Noviembre 78 41 119
2022 Octubre 121 51 172
2022 Septiembre 67 40 107
2022 Agosto 65 58 123
2022 Julio 61 43 104
2022 Junio 81 39 120
2022 Mayo 71 49 120
2022 Abril 108 57 165
2022 Marzo 106 50 156
2022 Febrero 96 37 133
2022 Enero 88 64 152
2021 Diciembre 74 45 119
2021 Noviembre 84 51 135
2021 Octubre 83 79 162
2021 Septiembre 88 51 139
2021 Agosto 60 68 128
2021 Julio 61 81 142
2021 Junio 98 38 136
2021 Mayo 91 71 162
2021 Abril 126 101 227
2021 Marzo 99 48 147
2021 Febrero 84 33 117
2021 Enero 44 23 67
2020 Diciembre 73 25 98
2020 Noviembre 58 27 85
2020 Octubre 44 26 70
2020 Septiembre 90 33 123
2020 Agosto 39 31 70
2020 Julio 48 19 67
2020 Junio 50 17 67
2020 Mayo 58 30 88
2020 Abril 49 19 68
2020 Marzo 57 28 85
2020 Febrero 57 42 99
2020 Enero 81 27 108
2019 Diciembre 51 35 86
2019 Noviembre 44 19 63
2019 Octubre 108 33 141
2019 Septiembre 85 46 131
2019 Agosto 445 24 469
2019 Julio 62 20 82
2019 Junio 73 25 98
2019 Mayo 63 67 130
2019 Abril 49 43 92
2019 Marzo 74 20 94
2019 Febrero 30 26 56
2019 Enero 37 43 80
2018 Diciembre 85 80 165
2018 Noviembre 56 25 81
2018 Octubre 1 2 3
2018 Septiembre 1 0 1
2018 Julio 1 0 1
2018 Junio 3 2 5
2018 Mayo 3 2 5
2018 Abril 2 11 13
2018 Marzo 0 15 15
2018 Febrero 0 11 11
2018 Enero 0 14 14
2017 Diciembre 0 10 10
2017 Noviembre 0 8 8
2017 Octubre 0 11 11
2017 Septiembre 0 12 12
2017 Agosto 0 9 9
2017 Julio 0 22 22
2017 Junio 0 17 17
2017 Mayo 0 27 27
2017 Abril 0 25 25
2017 Marzo 0 30 30
2017 Febrero 0 32 32
2017 Enero 0 67 67
2016 Diciembre 0 3 3
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Reumatología Clínica
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?