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Show me your skin and I will tell you who you are
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array:23 [ "pii" => "S2531043721000908" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2021.03.010" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1618" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Pulmonol. 2021;27:381-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:19 [ "pii" => "S2531043721000398" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2021.01.006" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "1594" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:375-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Screening of inhalation technique and treatment adherence in asthma, COPD and ACO patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "375" "paginaFinal" => "380" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 2917 "Tamanyo" => 258520 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Description of the number of errors per patient and per device type in each evaluation.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Each column represents the number (%) of errors per device type in every evaluation, from the first to the third, respectively from the top to the bottom. DPI: dry powder inhalers; MDI: metered-dose inhalers. DPI: first evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>109, second evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>99, third evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97; Respimat®: first evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8, second evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8, third evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11; MDI: first evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28, second evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56, third evaluation n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Nobre Pereira, T. Marques, V. Areias, C. Guerreiro, K. Cunha, H. Ramos" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Nobre Pereira" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Marques" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Areias" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Guerreiro" ] 4 => array:2 [ "nombre" => "K." "apellidos" => "Cunha" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Ramos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043721000398?idApp=UINPBA00004E" "url" => "/25310437/0000002700000004/v1_202107020810/S2531043721000398/v1_202107020810/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images</span>" "titulo" => "Show me your skin and I will tell you who you are" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "381" "paginaFinal" => "382" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Catarina Cascais-Costa, Catarina S. Carvalho, Carla Valente, Gilberto Teixeira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Catarina" "apellidos" => "Cascais-Costa" "email" => array:1 [ 0 => "catarinacascaisc@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "Catarina S." "apellidos" => "Carvalho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 2 => array:3 [ "nombre" => "Carla" "apellidos" => "Valente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 3 => array:3 [ "nombre" => "Gilberto" "apellidos" => "Teixeira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Centro Hospitalar Baixo Vouga – Hospital Infante D. Pedro, Aveiro, Portugal" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Intensive Medicine Department, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal" "etiqueta" => "b" "identificador" => "aff0002" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1500 "Ancho" => 1500 "Tamanyo" => 165514 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Patient's CT scan.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. tuberculosis</span> infection remains a highly relevant topic worldwide and it is estimated that approximately 25% of the population is infected, with 95% of cases occurring in developing countries<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a>.</p><p id="para0003" class="elsevierStylePara elsevierViewall">The manifestations of tuberculosis can be divided into pulmonary and extrapulmonary, the latter occurring in approximately 15% of cases<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a>. Skin involvement in tuberculosis is rare, and represents less than 2% of extrapulmonary manifestations<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>.</p><p id="para0004" class="elsevierStylePara elsevierViewall">The main agent responsible for the skin lesions is <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, but they can also be caused by <span class="elsevierStyleItalic">M. bovis</span> or the BCG vaccine<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>. They can manifest as inflammatory papules, verrucous plaques, chronic ulcers or suppurative nodes, as in the case presented<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>. This variety results from the mechanism of entry of <span class="elsevierStyleItalic">M. tuberculosis</span> into the skin (autoinoculation, exogenous inoculation or hematogenous route) <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>, the patient's immune status, sensitization of the host to the agent <a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>, factors inherent to the host such as age, sex and race, and environmental factors such as climate and geographic location <a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>.</p><p id="para0005" class="elsevierStylePara elsevierViewall">Skin lesions are essentially divided into <span class="elsevierStyleItalic">true cutaneous TB</span>, a direct result of infection, and <span class="elsevierStyleItalic">tuberculids</span>, indicating hypersensitivity to <span class="elsevierStyleItalic">M. tuberculosis</span> antigens<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>. Sarcoidosis, abscesses, and nontuberculous infections are common differential diagnoses<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>. The diagnosis can be challenging, culture and histological study must be performed, histopathology can show nonspecific inflammation, without the formation of granulomas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>. The definitive diagnosis is confirmed by a positive culture for <span class="elsevierStyleItalic">M. tuberculosis</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>.</p><p id="para0006" class="elsevierStylePara elsevierViewall">The authors present the case report of a 75-year-old independent man who visited his Assistant Physician due to a 6-month history, approximately, of multiple, recurrent, suppurating skin lesions in the right and left supraclavicular regions and upper thoracic regions.</p><p id="para0007" class="elsevierStylePara elsevierViewall">On physical examination, the lesions had painless, granulomatous ulcer with a fibrinous base and the patient had another abscess next to the sternocleidomastoid muscle. He also showed signs of collateral circulation (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>).</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0008" class="elsevierStylePara elsevierViewall">This was immunocompetent patient with no relevant medical history and no usual chronic medication. Laboratory results showed a slight increase in inflammatory markers (PCR 5.81 mg/dl) with negative procalcitonin and serum tumor markers. Computed tomography of the neck and chest showed several abscesses, namely in the right and posterior lateral cervical region and in the right supraclavicular cavity (<a class="elsevierStyleCrossRef" href="#fig0002">Fig. 2</a>), there was no pulmonary involvement. The patient underwent a video bronchial fibroscopy that showed no endobronchial lesions; the microbiology and cytology of the aspirate and bronchoalveolar lavage were negative.</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0009" class="elsevierStylePara elsevierViewall">The abscess in the right supraclavicular cavity was aspirated. The cytology revealed a necrotic area with an associated inflammatory process and the culture in Loewenstein-Zensen medium was positive for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>. The patient was sent to the Pneumology Diagnosis Center (CDP) and began treatment with the four initial antitubercular drugs (isoniazid 300 mg/day, rifampin 600 mg/day, pyrazinamide 1500 mg/day and ethambutol 1200 mg/day).</p><p id="para0010" class="elsevierStylePara elsevierViewall">The treatment is similar to that of systemic tuberculosis, with tuberculostatic drugs<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a>, and biopsies or surgical debridement may sometimes be necessary<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>. With the exception of disseminated miliary cutaneous forms, skin lesions respond well to treatment and have a good prognosis <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>.</p><p id="para0011" class="elsevierStylePara elsevierViewall">With this case, the authors intend to show a rare form of a condition that still has a very negative impact on World Public Health, reinforcing the need to maintain strong clinical suspicion <a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> so as not to delay the start of effective therapy.</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Funding</span><p id="para0012" class="elsevierStylePara elsevierViewall">The authors declare that no funding was received for this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0001" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="notep0001">IMAGES: Show me your skin and I will tell you who you are</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="para0013a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>" "etiqueta" => "Appendix" "titulo" => "Supplementary materials" "identificador" => "sec0003" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1689 "Ancho" => 1250 "Tamanyo" => 197440 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Patient's skin lesions.</p>" ] ] 1 => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1500 "Ancho" => 1500 "Tamanyo" => 165514 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Patient's CT scan.</p>" ] ] 2 => array:6 [ "identificador" => "ecom0001" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Image, application " "rol" => "short" ] ] "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 13621 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Horsburgh R, Fordham von Reyn C, Baron E. Epidemiology of tuberculosis. UpToDate. 2021. Available at: <a target="_blank" href="https://www.uptodate.com/contents/epidemiology-of-tuberculosis">https://www.uptodate.com/contents/epidemiology-of-tuberculosis</a>. Accessed on: 06/02/2021." ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bernardo J, Fordham von Reyn C, Baron E. Epidemiology and pathology of miliary and extrapulmonary tuberculosis. UpToDate. 2020. Available at: <a target="_blank" href="https://www.uptodate.com/contents/epidemiology-and-pathology-of-miliary-and-extrapulmonary-tuberculosis">https://www.uptodate.com/contents/epidemiology-and-pathology-of-miliary-and-extrapulmonary-tuberculosis</a>. Accessed on: 06/02/2021." ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Handog E, Macarayo MJ, Rosen T, Ofori A. Cutaneous manifestations of tuberculosis. UpToDate 2020. Available at: <a target="_blank" href="https://www.uptodate.com/contents/cutaneous-manifestations-of-tuberculosis">https://www.uptodate.com/contents/cutaneous-manifestations-of-tuberculosis</a>. Accessed on 06/02/2021." ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - part I" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.B. Santos" 1 => "A.R. Figueiredo" 2 => "C.E. Ferraz" 3 => "M.H. Oliveira" 4 => "P.G. Silva" 5 => "V.L. Medeiros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20142334" "Revista" => array:6 [ "tituloSerie" => "Ann Bras Dermatol." "fecha" => "2014" "volumen" => "89" "numero" => "2" "paginaInicial" => "219" "paginaFinal" => "228" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous Tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.K. Hill" 1 => "C.V. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/microbiolspec.TNMI7-0010-2016" "Libro" => array:1 [ "fecha" => "2017 Jan" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002700000004/v1_202107020810/S2531043721000908/v1_202107020810/en/main.assets" "Apartado" => array:4 [ "identificador" => "88777" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002700000004/v1_202107020810/S2531043721000908/v1_202107020810/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043721000908?idApp=UINPBA00004E" ]
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