array:24 [
  "pii" => "S0365059620301276"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2019.11.010"
  "estado" => "S300"
  "fechaPublicacion" => "2020-07-01"
  "aid" => "199"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by/4.0/"
  "subdocumento" => "sco"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S2666275220302010"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2020.05.011"
      "estado" => "S300"
      "fechaPublicacion" => "2020-07-01"
      "aid" => "199"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "sco"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta &#8211; Caso cl&#237;nico</span>"
        "titulo" => "Pustulose exantem&#225;tica generalizada aguda secund&#225;ria &#224; amiodarona&#44; com aspectos semelhantes &#224; necr&#243;lise epid&#233;rmica t&#243;xica"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "540"
            "paginaFinal" => "542"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 941
                "Ancho" => 755
                "Tamanyo" => 126336
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es bolhosas que evoluem com pequenas eros&#245;es nos flancos&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Cheryl Distel, Mar&#237;a Luz Bollea Garlatti, Ana Clara Torre, Julia Riganti"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Cheryl"
                "apellidos" => "Distel"
              ]
              1 => array:2 [
                "nombre" => "Mar&#237;a Luz"
                "apellidos" => "Bollea Garlatti"
              ]
              2 => array:2 [
                "nombre" => "Ana Clara"
                "apellidos" => "Torre"
              ]
              3 => array:2 [
                "nombre" => "Julia"
                "apellidos" => "Riganti"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059620301276"
          "doi" => "10.1016/j.abd.2019.11.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301276?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302010?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009500000004/v2_202008070652/S2666275220302010/v2_202008070652/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059620301367"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.12.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-07-01"
    "aid" => "208"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "sco"
    "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">Case Letter</span>"
      "titulo" => "ASIA case after injection of liquid silicone"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "542"
          "paginaFinal" => "544"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 1299
              "Ancho" => 905
              "Tamanyo" => 102162
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lateral view of left thigh&#46; Hardened&#44; brownish&#44; scaly plaque&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Camila Secco Libardi, Lucia Martins Diniz, Carlos Musso, Bruna Anjos Badar&#243;"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Camila Secco"
              "apellidos" => "Libardi"
            ]
            1 => array:2 [
              "nombre" => "Lucia Martins"
              "apellidos" => "Diniz"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Musso"
            ]
            3 => array:2 [
              "nombre" => "Bruna Anjos"
              "apellidos" => "Badar&#243;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220301983"
        "doi" => "10.1016/j.abdp.2020.05.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301983?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301367?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301367/v3_202008041755/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0365059620301252"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.10.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-07-01"
    "aid" => "197"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "sco"
    "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">Case Letter</span>"
      "titulo" => "Rare presentation of Rothmund-Thomson syndrome with novel compound heterozygous mutations of the RECQL4 gene"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "538"
          "paginaFinal" => "540"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1413
              "Ancho" => 2079
              "Tamanyo" => 268529
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Two novel heterozygous variants in the RECQL4 gene confirmed by gene sequencing&#46; One was in the splice site&#44; c&#46;1391-2A&#62;C from her father&#44; and also was seen in her sister&#46; The other was a deletion mutation&#44; c&#46;2492&#95;2493delAT &#40;p&#46;His831Argfs&#41; from her mother&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Xinyue Zhang, Songmei Geng, Yi Zheng"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Xinyue"
              "apellidos" => "Zhang"
            ]
            1 => array:2 [
              "nombre" => "Songmei"
              "apellidos" => "Geng"
            ]
            2 => array:2 [
              "nombre" => "Yi"
              "apellidos" => "Zheng"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220302083"
        "doi" => "10.1016/j.abdp.2020.05.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302083?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301252?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301252/v3_202008041755/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>"
    "titulo" => "Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "540"
        "paginaFinal" => "542"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Cheryl Distel, Mar&#237;a Luz Bollea Garlatti, Ana Clara Torre, Julia Riganti"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Cheryl"
            "apellidos" => "Distel"
            "email" => array:1 [
              0 => "cheryldistel@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Mar&#237;a Luz"
            "apellidos" => "Bollea Garlatti"
          ]
          2 => array:2 [
            "nombre" => "Ana Clara"
            "apellidos" => "Torre"
          ]
          3 => array:2 [
            "nombre" => "Julia"
            "apellidos" => "Riganti"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Dermatology&#44; Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 941
            "Ancho" => 755
            "Tamanyo" => 126336
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bullous lesions that led to small erosions on flanks&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute generalized exanthematous pustulosis &#40;AGEP&#41; is an infrequent cutaneous drug eruption&#44; with a short latency of 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h between the exposure and the onset of lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The symptoms consist of fever and small&#44; sterile&#44; non-follicular pustules on a background of erythema&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Mucous membrane and internal organ involvement are unusual&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The most common laboratory abnormality is leukocytosis and neutrophilia<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7000&#47;mL&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A score&#44; developed by the EuroSCAR group&#44; that takes into account clinical and histopathological criteria is useful for diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> AGEP is usually a self-limited disease&#44; which typically resolves with cutaneous desquamation in less than 15<span class="elsevierStyleHsp" style=""></span>days after suspending the causative drug&#44; and it has an excellent prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However&#44; although infrequent&#44; patients can develop purpuric&#44; targetoid&#44; and bullous lesions&#44; areas of denuded skin&#44; a positive Nikolsky sign&#44; and mucosal and multi-organ involvements&#44; which denotes a more serious outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The present report describes a patient with AGEP induced by an atypical drug&#44; who presented with this serious clinical picture&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 69-year-old female patient&#44; with a history of supraventricular extrasystoles&#44; presented with fever&#44; malaise&#44; and small&#44; non-follicular pustules on a background of erythema in the axillae and groin&#46; Twenty-four hours earlier she had switched her antiarrhythmic treatment from bisoprolol to amiodarone&#46; Upon admission&#44; she was dyspneic and presented tachycardia&#44; tachypnea&#44; and suboptimal oxygen saturation&#46; Her mucous membranes were not involved and the Nikolsky sign was negative&#46; Her laboratory studies revealed leukocytosis &#40;26&#44;689<span class="elsevierStyleHsp" style=""></span>cell&#47;mm<span class="elsevierStyleSup">3</span>&#41; with neutrophilia &#40;88&#46;25&#37;&#41;&#46; Blood cultures showed no growth and the chest X-ray did not reveal any abnormalities&#46; AGEP was suspected&#44; amiodarone was suspended&#44; skin biopsies were obtained&#44; and oral meprednisone 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day was started because of her pulmonary symptoms&#46; Histopathology revealed subcorneal pustules with no necrotic keratinocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The EuroSCAR score was 11&#44; compatible with definite AGEP&#46; In spite of the initial treatment&#44; 24<span class="elsevierStyleHsp" style=""></span>h later the patient&#39;s lesions evolved and extended&#46; She experienced diarrhea and developed purpuric and targetoid lesions in the thighs and the gluteal area &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#59; and bullous lesions that led to small erosions on her flanks &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Nikolsky sign was again negative&#46; Taking into account this torpid progression&#44; it was hypothesized that intestinal absorption of corticosteroid could not have been sufficient&#44; the prolonged half-life of amiodarone was playing a role&#44; and the patient could have been undergoing a different drug reaction such as toxic epidermal necrolysis &#40;TEN&#41; or that she could have been suffering from an overlapping of two adverse drug reactions&#46; At this point new skin biopsies were obtained&#46; The histopathology was again compatible with AGEP&#46; Meprednisone dose was raised to 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day and was administered intravenously&#46; Finally&#44; the skin lesions and systemic symptoms resolved with skin desquamation 11 days after the onset&#46; However&#44; after five months from the onset of symptoms&#44; she continued to developed new recurrences every time corticosteroid was intended to be suspended&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The relationship between the beginning of the new antiarrhythmic and the development of systemic and cutaneous symptoms&#44; together with the clinical and histopathological findings&#44; resulted in the diagnosis of AGEP induced by amiodarone&#46; After extended research of the English and Spanish literature&#44; to the best of the authors&#8217; knowledge&#44; this is the first report of AGEP triggered by this medication&#46; Amiodarone is a fat soluble drug with a prolonged half-life of 15&#8211;142<span class="elsevierStyleHsp" style=""></span>days &#40;mean of 58&#41; even after the administration of a single dose&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This could explain why the patient kept presenting new lesions after the discontinuation of the drug even though the medication had been suspended&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This case exhibited unusual features for classical AGEP&#58; targetoid and bullous lesions together with torpid evolution and internal organ involvement&#46; A diagnosis of TEN was considered&#44; but in the absence of necrotic keratinocytes in the biopsy&#44; it was concluded that this was actually TEN-like AGEP presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although internal organ involvement is present in less than 17&#8211;20&#37; of patients&#44; when it occurs&#44; hepatic and renal failure are the most common manifestations&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> It can also present with respiratory symptoms<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> as in the present patient&#44; in whom after ruling out infectious causes and TEN&#44; pulmonary involvement was attributed to AGEP&#46; Moreover&#44; though in classical AGEP the cessation of the causative drug is the only necessary intervention&#44; systemic corticosteroids are mandatory when organ involvement or severe cutaneous lesions are present&#44; as in the present case&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that this case supports the decision of some authors to consider AGEP a severe cutaneous drug reaction and why it is important to closely follow these patients&#44; in order to identify critical cases and intensify treatment to reduce mortality rate&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Cheryl Distel&#58; Drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Mar&#237;a Luz Bollea Garlatti&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ana Clara Torre&#58; Approval of the final version of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Julia Riganti&#58; Approval of the final version of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Authors&#8217; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:2 [
          "identificador" => "xack475739"
          "titulo" => "Acknowledgment"
        ]
        4 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-06-28"
    "fechaAceptado" => "2019-11-30"
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Distel C&#44; Bollea Garlatti ML&#44; Torre AC&#44; Riganti J&#46; Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone&#46; An Bras Dermatol&#46; 2020&#59;95&#58;540&#8211;2&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1007
            "Ancho" => 755
            "Tamanyo" => 239441
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Subcorneal pustules and spongiosis &#40;Hematoxylin &#38; eosin&#44; x100&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 579
            "Ancho" => 755
            "Tamanyo" => 58707
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Purpuric and targetoid lesions in the thighs and the gluteal area&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 941
            "Ancho" => 755
            "Tamanyo" => 126336
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bullous lesions that led to small erosions on flanks&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis&#58; pathogenesis&#44; genetic background&#44; clinical variants and therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Feldmeyer"
                            1 => "K&#46; Heidemeyer"
                            2 => "N&#46; Yawalkar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Mol Sci"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "1214"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis &#40;AGEP&#41;&#58; a review and update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Szatkowski"
                            1 => "R&#46;A&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2015.07.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2015"
                        "volumen" => "73"
                        "paginaInicial" => "843"
                        "paginaFinal" => "848"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26354880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis induced by hydroxychloroquine&#58; a case with atypical clinical presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Duman"
                            1 => "I&#46;O&#46; Topal"
                            2 => "E&#46; Kocaturk"
                            3 => "K&#46; Cure"
                            4 => "I&#46; Mansuroglu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20175561"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2017"
                        "volumen" => "92"
                        "paginaInicial" => "404"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29186260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "UpToDate &#91;Internet&#93;&#46; Amiodarone&#58; drug information&#46; Available from&#58; <a target="_blank" href="https://www.uptodate.com/contents/amiodarone-drug-information">https&#58;&#47;&#47;www&#46;uptodate&#46;com&#47;contents&#47;amiodarone-drug-information</a> &#91;accessed 12&#46;11&#46;18&#93;&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis&#58; atypical presentations and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;C&#46; Kostopoulos"
                            1 => "S&#46;M&#46; Krishna"
                            2 => "N&#46;K&#46; Brinster"
                            3 => "A&#46;G&#46; Ortega-Loayza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12721"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "209"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25201706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack475739"
        "titulo" => "Acknowledgment"
        "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">The authors are very thankful to Dr&#46; Luis Mazzuoccolo&#44; head of the Department of Dermatology&#44; Hospital Italiano de Buenos Aires&#44; for critical review and approval of the final version of the manuscript&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301276/v3_202008041755/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "82769"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Letter"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000004/v3_202008041755/S0365059620301276/v3_202008041755/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301276?idApp=UINPBA00008Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Case Letter
Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone
Cheryl Distel
Corresponding author
cheryldistel@gmail.com

Corresponding author.
, María Luz Bollea Garlatti, Ana Clara Torre, Julia Riganti
Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Read
6328
Times
was read the article
2869
Total PDF
3459
Total HTML
Share statistics
 array:24 [
  "pii" => "S0365059620301276"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2019.11.010"
  "estado" => "S300"
  "fechaPublicacion" => "2020-07-01"
  "aid" => "199"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by/4.0/"
  "subdocumento" => "sco"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S2666275220302010"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2020.05.011"
      "estado" => "S300"
      "fechaPublicacion" => "2020-07-01"
      "aid" => "199"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "sco"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta &#8211; Caso cl&#237;nico</span>"
        "titulo" => "Pustulose exantem&#225;tica generalizada aguda secund&#225;ria &#224; amiodarona&#44; com aspectos semelhantes &#224; necr&#243;lise epid&#233;rmica t&#243;xica"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "540"
            "paginaFinal" => "542"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 941
                "Ancho" => 755
                "Tamanyo" => 126336
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Les&#245;es bolhosas que evoluem com pequenas eros&#245;es nos flancos&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Cheryl Distel, Mar&#237;a Luz Bollea Garlatti, Ana Clara Torre, Julia Riganti"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Cheryl"
                "apellidos" => "Distel"
              ]
              1 => array:2 [
                "nombre" => "Mar&#237;a Luz"
                "apellidos" => "Bollea Garlatti"
              ]
              2 => array:2 [
                "nombre" => "Ana Clara"
                "apellidos" => "Torre"
              ]
              3 => array:2 [
                "nombre" => "Julia"
                "apellidos" => "Riganti"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059620301276"
          "doi" => "10.1016/j.abd.2019.11.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301276?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302010?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009500000004/v2_202008070652/S2666275220302010/v2_202008070652/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059620301367"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.12.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-07-01"
    "aid" => "208"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "sco"
    "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">Case Letter</span>"
      "titulo" => "ASIA case after injection of liquid silicone"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "542"
          "paginaFinal" => "544"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 1299
              "Ancho" => 905
              "Tamanyo" => 102162
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lateral view of left thigh&#46; Hardened&#44; brownish&#44; scaly plaque&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Camila Secco Libardi, Lucia Martins Diniz, Carlos Musso, Bruna Anjos Badar&#243;"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Camila Secco"
              "apellidos" => "Libardi"
            ]
            1 => array:2 [
              "nombre" => "Lucia Martins"
              "apellidos" => "Diniz"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Musso"
            ]
            3 => array:2 [
              "nombre" => "Bruna Anjos"
              "apellidos" => "Badar&#243;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220301983"
        "doi" => "10.1016/j.abdp.2020.05.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301983?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301367?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301367/v3_202008041755/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0365059620301252"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2019.10.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-07-01"
    "aid" => "197"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "sco"
    "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">Case Letter</span>"
      "titulo" => "Rare presentation of Rothmund-Thomson syndrome with novel compound heterozygous mutations of the RECQL4 gene"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "538"
          "paginaFinal" => "540"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1413
              "Ancho" => 2079
              "Tamanyo" => 268529
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Two novel heterozygous variants in the RECQL4 gene confirmed by gene sequencing&#46; One was in the splice site&#44; c&#46;1391-2A&#62;C from her father&#44; and also was seen in her sister&#46; The other was a deletion mutation&#44; c&#46;2492&#95;2493delAT &#40;p&#46;His831Argfs&#41; from her mother&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Xinyue Zhang, Songmei Geng, Yi Zheng"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Xinyue"
              "apellidos" => "Zhang"
            ]
            1 => array:2 [
              "nombre" => "Songmei"
              "apellidos" => "Geng"
            ]
            2 => array:2 [
              "nombre" => "Yi"
              "apellidos" => "Zheng"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275220302083"
        "doi" => "10.1016/j.abdp.2020.05.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220302083?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301252?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301252/v3_202008041755/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>"
    "titulo" => "Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "540"
        "paginaFinal" => "542"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Cheryl Distel, Mar&#237;a Luz Bollea Garlatti, Ana Clara Torre, Julia Riganti"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Cheryl"
            "apellidos" => "Distel"
            "email" => array:1 [
              0 => "cheryldistel@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Mar&#237;a Luz"
            "apellidos" => "Bollea Garlatti"
          ]
          2 => array:2 [
            "nombre" => "Ana Clara"
            "apellidos" => "Torre"
          ]
          3 => array:2 [
            "nombre" => "Julia"
            "apellidos" => "Riganti"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Dermatology&#44; Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 941
            "Ancho" => 755
            "Tamanyo" => 126336
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bullous lesions that led to small erosions on flanks&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute generalized exanthematous pustulosis &#40;AGEP&#41; is an infrequent cutaneous drug eruption&#44; with a short latency of 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h between the exposure and the onset of lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The symptoms consist of fever and small&#44; sterile&#44; non-follicular pustules on a background of erythema&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Mucous membrane and internal organ involvement are unusual&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The most common laboratory abnormality is leukocytosis and neutrophilia<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7000&#47;mL&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A score&#44; developed by the EuroSCAR group&#44; that takes into account clinical and histopathological criteria is useful for diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> AGEP is usually a self-limited disease&#44; which typically resolves with cutaneous desquamation in less than 15<span class="elsevierStyleHsp" style=""></span>days after suspending the causative drug&#44; and it has an excellent prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However&#44; although infrequent&#44; patients can develop purpuric&#44; targetoid&#44; and bullous lesions&#44; areas of denuded skin&#44; a positive Nikolsky sign&#44; and mucosal and multi-organ involvements&#44; which denotes a more serious outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The present report describes a patient with AGEP induced by an atypical drug&#44; who presented with this serious clinical picture&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 69-year-old female patient&#44; with a history of supraventricular extrasystoles&#44; presented with fever&#44; malaise&#44; and small&#44; non-follicular pustules on a background of erythema in the axillae and groin&#46; Twenty-four hours earlier she had switched her antiarrhythmic treatment from bisoprolol to amiodarone&#46; Upon admission&#44; she was dyspneic and presented tachycardia&#44; tachypnea&#44; and suboptimal oxygen saturation&#46; Her mucous membranes were not involved and the Nikolsky sign was negative&#46; Her laboratory studies revealed leukocytosis &#40;26&#44;689<span class="elsevierStyleHsp" style=""></span>cell&#47;mm<span class="elsevierStyleSup">3</span>&#41; with neutrophilia &#40;88&#46;25&#37;&#41;&#46; Blood cultures showed no growth and the chest X-ray did not reveal any abnormalities&#46; AGEP was suspected&#44; amiodarone was suspended&#44; skin biopsies were obtained&#44; and oral meprednisone 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day was started because of her pulmonary symptoms&#46; Histopathology revealed subcorneal pustules with no necrotic keratinocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The EuroSCAR score was 11&#44; compatible with definite AGEP&#46; In spite of the initial treatment&#44; 24<span class="elsevierStyleHsp" style=""></span>h later the patient&#39;s lesions evolved and extended&#46; She experienced diarrhea and developed purpuric and targetoid lesions in the thighs and the gluteal area &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#59; and bullous lesions that led to small erosions on her flanks &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Nikolsky sign was again negative&#46; Taking into account this torpid progression&#44; it was hypothesized that intestinal absorption of corticosteroid could not have been sufficient&#44; the prolonged half-life of amiodarone was playing a role&#44; and the patient could have been undergoing a different drug reaction such as toxic epidermal necrolysis &#40;TEN&#41; or that she could have been suffering from an overlapping of two adverse drug reactions&#46; At this point new skin biopsies were obtained&#46; The histopathology was again compatible with AGEP&#46; Meprednisone dose was raised to 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day and was administered intravenously&#46; Finally&#44; the skin lesions and systemic symptoms resolved with skin desquamation 11 days after the onset&#46; However&#44; after five months from the onset of symptoms&#44; she continued to developed new recurrences every time corticosteroid was intended to be suspended&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The relationship between the beginning of the new antiarrhythmic and the development of systemic and cutaneous symptoms&#44; together with the clinical and histopathological findings&#44; resulted in the diagnosis of AGEP induced by amiodarone&#46; After extended research of the English and Spanish literature&#44; to the best of the authors&#8217; knowledge&#44; this is the first report of AGEP triggered by this medication&#46; Amiodarone is a fat soluble drug with a prolonged half-life of 15&#8211;142<span class="elsevierStyleHsp" style=""></span>days &#40;mean of 58&#41; even after the administration of a single dose&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This could explain why the patient kept presenting new lesions after the discontinuation of the drug even though the medication had been suspended&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This case exhibited unusual features for classical AGEP&#58; targetoid and bullous lesions together with torpid evolution and internal organ involvement&#46; A diagnosis of TEN was considered&#44; but in the absence of necrotic keratinocytes in the biopsy&#44; it was concluded that this was actually TEN-like AGEP presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although internal organ involvement is present in less than 17&#8211;20&#37; of patients&#44; when it occurs&#44; hepatic and renal failure are the most common manifestations&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> It can also present with respiratory symptoms<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> as in the present patient&#44; in whom after ruling out infectious causes and TEN&#44; pulmonary involvement was attributed to AGEP&#46; Moreover&#44; though in classical AGEP the cessation of the causative drug is the only necessary intervention&#44; systemic corticosteroids are mandatory when organ involvement or severe cutaneous lesions are present&#44; as in the present case&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that this case supports the decision of some authors to consider AGEP a severe cutaneous drug reaction and why it is important to closely follow these patients&#44; in order to identify critical cases and intensify treatment to reduce mortality rate&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Cheryl Distel&#58; Drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Mar&#237;a Luz Bollea Garlatti&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ana Clara Torre&#58; Approval of the final version of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Julia Riganti&#58; Approval of the final version of the manuscript&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Authors&#8217; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:2 [
          "identificador" => "xack475739"
          "titulo" => "Acknowledgment"
        ]
        4 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-06-28"
    "fechaAceptado" => "2019-11-30"
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Distel C&#44; Bollea Garlatti ML&#44; Torre AC&#44; Riganti J&#46; Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone&#46; An Bras Dermatol&#46; 2020&#59;95&#58;540&#8211;2&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1007
            "Ancho" => 755
            "Tamanyo" => 239441
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Subcorneal pustules and spongiosis &#40;Hematoxylin &#38; eosin&#44; x100&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 579
            "Ancho" => 755
            "Tamanyo" => 58707
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Purpuric and targetoid lesions in the thighs and the gluteal area&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 941
            "Ancho" => 755
            "Tamanyo" => 126336
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bullous lesions that led to small erosions on flanks&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis&#58; pathogenesis&#44; genetic background&#44; clinical variants and therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Feldmeyer"
                            1 => "K&#46; Heidemeyer"
                            2 => "N&#46; Yawalkar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Mol Sci"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "1214"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis &#40;AGEP&#41;&#58; a review and update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Szatkowski"
                            1 => "R&#46;A&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2015.07.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2015"
                        "volumen" => "73"
                        "paginaInicial" => "843"
                        "paginaFinal" => "848"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26354880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis induced by hydroxychloroquine&#58; a case with atypical clinical presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Duman"
                            1 => "I&#46;O&#46; Topal"
                            2 => "E&#46; Kocaturk"
                            3 => "K&#46; Cure"
                            4 => "I&#46; Mansuroglu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20175561"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2017"
                        "volumen" => "92"
                        "paginaInicial" => "404"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29186260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "UpToDate &#91;Internet&#93;&#46; Amiodarone&#58; drug information&#46; Available from&#58; <a target="_blank" href="https://www.uptodate.com/contents/amiodarone-drug-information">https&#58;&#47;&#47;www&#46;uptodate&#46;com&#47;contents&#47;amiodarone-drug-information</a> &#91;accessed 12&#46;11&#46;18&#93;&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute generalized exanthematous pustulosis&#58; atypical presentations and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;C&#46; Kostopoulos"
                            1 => "S&#46;M&#46; Krishna"
                            2 => "N&#46;K&#46; Brinster"
                            3 => "A&#46;G&#46; Ortega-Loayza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12721"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "209"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25201706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack475739"
        "titulo" => "Acknowledgment"
        "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">The authors are very thankful to Dr&#46; Luis Mazzuoccolo&#44; head of the Department of Dermatology&#44; Hospital Italiano de Buenos Aires&#44; for critical review and approval of the final version of the manuscript&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301276/v3_202008041755/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "82769"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Letter"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000004/v3_202008041755/S0365059620301276/v3_202008041755/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301276?idApp=UINPBA00008Z"
]
Article information
ISSN: 03650596
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 24 11 35
2024 October 119 68 187
2024 September 163 74 237
2024 August 139 99 238
2024 July 138 110 248
2024 June 100 72 172
2024 May 90 68 158
2024 April 110 88 198
2024 March 120 58 178
2024 February 118 75 193
2024 January 94 56 150
2023 December 77 65 142
2023 November 76 74 150
2023 October 73 77 150
2023 September 84 70 154
2023 August 68 35 103
2023 July 73 31 104
2023 June 69 40 109
2023 May 52 18 70
2023 April 51 18 69
2023 March 66 49 115
2023 February 53 28 81
2023 January 36 23 59
2022 December 54 24 78
2022 November 73 64 137
2022 October 62 55 117
2022 September 49 65 114
2022 August 64 44 108
2022 July 47 56 103
2022 June 44 55 99
2022 May 36 48 84
2022 April 36 44 80
2022 March 36 66 102
2022 February 46 29 75
2022 January 76 71 147
2021 December 39 55 94
2021 November 51 63 114
2021 October 67 82 149
2021 September 42 50 92
2021 August 46 63 109
2021 July 31 57 88
2021 June 35 68 103
2021 May 39 67 106
2021 April 78 222 300
2021 March 65 62 127
2021 February 21 20 41
2021 January 31 18 49
2020 December 25 18 43
2020 November 34 16 50
2020 October 68 8 76
2020 September 94 20 114
2020 August 21 12 33
2020 July 28 14 42
2020 June 20 16 36
2020 May 8 10 18
Show all

Follow this link to access the full text of the article

Idiomas
Anais Brasileiros de Dermatologia
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.