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embora haja relatos de ulcera&#231;&#227;o cut&#226;nea&#44; infartos testiculares e neuropatia&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ao exame histol&#243;gico&#44; a AML mostra um denso infiltrado de c&#233;lulas mononucleares na parede muscular das arter&#237;olas da jun&#231;&#227;o derme&#8208;subcut&#226;neo&#44; com estreitamento vari&#225;vel de seu l&#250;men por um t&#237;pico anel hialinizado de fibrina&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">12&#44;13</span></a> Alguns autores preferem se referir a ela como &#8220;arterite trombof&#237;lica linfoc&#237;tica&#8221; para enfatizar o suposto mecanismo patog&#234;nico associado a essa entidade&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> Na verdade&#44; &#233; question&#225;vel se a AML tem caracter&#237;sticas definidoras suficientes para ser considerada uma vasculite distinta da poliarterite nodosa cut&#226;nea &#40;PAN&#8208;C&#41;&#44; uma arterite necrotizante de vasos de m&#233;dio calibre com infiltrado predominantemente polimorfonuclear&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nosso objetivo foi avaliar retrospectivamente uma s&#233;rie de pacientes com diagn&#243;stico de AML&#44; a fim de analisar suas caracter&#237;sticas cl&#237;nicas&#44; histopatol&#243;gicas e laboratoriais&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica da Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; e todos os participantes preencheram o termo de consentimento informado&#46; Foram inclu&#237;dos sete pacientes diagnosticados com AML no Ambulat&#243;rio de Vasculites da Divis&#227;o de Dermatologia entre fevereiro de&#160;2005 e setembro de&#160;2017&#46; 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fator reumatoide &#40;FR&#41;&#44; anticorpo contra DNA dupla h&#233;lice&#44; anti&#8208;SSA&#44; anti&#8208;SSB e anticorpos anticitoplasma de neutr&#243;filos&#46; Uma breve pesquisa de trombofilias incluiu&#58; anticoagulante l&#250;pico&#59; anticorpos anticardiolipina &#40;aCL&#41; &#91;imunoglobulina &#40;Ig&#41; M e IgG&#93;&#59; anticorpos anti&#8208;&#946;2 glicoprote&#237;na I&#59; prote&#237;nas&#160;C&#160;e&#160;S&#59; pesquisa de muta&#231;&#227;o do fator V de Leiden&#59; muta&#231;&#227;o do gene da protrombina G20210A&#59; e n&#237;veis s&#233;ricos de antitrombina III&#44; fatores VIII e IX&#44; fibrinog&#234;nio&#44; homociste&#237;na e lipoprote&#237;na&#40;a&#41; &#91;Lp&#40;a&#41;&#93;&#46; Estudos proped&#234;uticos adicionais de ultrassonografia com <span class="elsevierStyleItalic">Doppler</span> de aorta abdominal&#44; il&#237;acas e art&#233;rias renais foram feitos em tr&#234;s pacientes desta s&#233;rie &#40;pacientes&#160;4&#44;&#160;5&#160;e&#160;6&#41;&#59; ultrassonografia com <span class="elsevierStyleItalic">Doppler</span> do sistema venoso&#44; em dois pacientes &#40;pacientes&#160;5&#160;e&#160;6&#41;&#59; e eletroneuromiografia&#44; em um paciente &#40;paciente&#160;6&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para a revis&#227;o da literatura&#44; em setembro de&#160;2018 fizemos buscas nas bases de dados <span class="elsevierStyleItalic">PubMed&#44; Web of Science e Scopus</span> com os termos &#8220;arterite macular linfoc&#237;tica&#8221;&#44; &#8220;arterite macular&#8221; ou &#8220;arterite trombof&#237;lica linfoc&#237;tica&#8221;&#46; Artigos relevantes foram identificados por inspe&#231;&#227;o manual das listas de refer&#234;ncias&#46; Dois investigadores avaliaram t&#237;tulos e resumos de maneira independente para determinar o potencial de inclus&#227;o dos trabalhos&#46; Ao todo&#44; 34&#160;artigos foram analisados&#46; Ap&#243;s excluir um estudo com dados incompletos&#44; foram resumidos os resultados de&#160;23&#160;artigos identificados como relato ou s&#233;rie de casos&#46; Eles ser&#227;o discutidos posteriormente neste artigo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os pacientes nesta s&#233;rie eram mulheres&#46; Elas foram classificadas de acordo com etnia&#47;cor da pele&#46; Seis eram brancas e uma era negra&#46; A idade variou de 9 a 46 anos&#44; com m&#233;dia ao diagn&#243;stico de 26&#44;71 &#40;DP &#61; 12&#44;44&#41;&#46; A dura&#231;&#227;o da doen&#231;a antes do diagn&#243;stico variou de 6 a 96 meses&#44; com m&#233;dia de 34&#44;42 &#40;DP &#61; 32&#44;88&#41;&#46; Hiperpigmenta&#231;&#227;o reticulada persistente foi encontrada em todas as pacientes&#44; seguida por livedo racemoso &#40;duas pacientes&#41; e&#44; em igual frequ&#234;ncia&#44; placas eritematosas e indura&#231;&#245;es subcut&#226;neas sutis &#40;uma paciente cada&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; N&#227;o houve evid&#234;ncia de ulcera&#231;&#227;o&#44; atrofia branca&#44; n&#243;dulos ou p&#250;rpura palp&#225;vel&#46; As pernas foram afetadas em todas as pacientes&#44; enquanto os bra&#231;os e o tronco em uma paciente cada&#46; As les&#245;es se apresentaram simetricamente quando acometeram as pernas&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Sintomas referidos no mesmo segmento corporal onde se encontravam as les&#245;es cut&#226;neas foram encontrados em tr&#234;s pacientes&#46; Uma delas &#40;paciente&#160;6&#41; queixou&#8208;se de parestesia e dor&#59; por essa raz&#227;o&#44; uma eletroneuromiografia foi feita&#44; mas n&#227;o apresentou altera&#231;&#245;es&#44; enquanto uma ultrassonografia do sistema venoso dos membros inferiores revelou insufici&#234;ncia venosa cr&#244;nica devido a um refluxo prim&#225;rio da safena magna na perna esquerda&#46; Estudos de ultrassonografia com <span class="elsevierStyleItalic">Doppler</span> da aorta abdominal&#44; art&#233;rias il&#237;acas e renais das pacientes 4&#44; 5 e 6 resultaram normais&#44; assim como uma ultrassonografia do sistema venoso dos membros inferiores da paciente 5&#46; Nenhuma das pacientes tinha hist&#243;ria de trombose arterial ou venosa&#46; Uma das pacientes era ex&#8208;tabagista&#44; diagnosticada e tratada para tuberculose pulmonar quatro anos antes da admiss&#227;o&#46; Esfrega&#231;o para baciloscopia do escarro e tomografia computadorizada do t&#243;rax n&#227;o mostraram sinais de doen&#231;a ativa&#46; Duas pacientes foram diagnosticadas com migr&#226;nea e foram acompanhadas pela equipe de neurologia do hospital&#46; Dados demogr&#225;ficos&#44; achados histopatol&#243;gicos&#44; tratamento e dura&#231;&#227;o do seguimento est&#227;o representados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o laboratorial mostrou poucas altera&#231;&#245;es&#44; como baixa atividade de prote&#237;na&#160;S 28&#37; &#40;VR 55&#37;&#8208;160&#37;&#41; &#40;paciente&#160;3&#41;&#59; FAN de 1&#58;80 com padr&#227;o nuclear pontilhado fino e n&#237;vel de fibrinog&#234;nio ligeiramente elevado 406<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;VR 150&#8208;400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; &#40;paciente&#160;5&#41;&#46; Duas pacientes apresentaram t&#237;tulos significativamente positivos de anticorpos aCL IgM em testes repetidos &#40;pacientes&#160;1&#160;e&#160;3&#41;&#44; uma das quais apresentava tamb&#233;m t&#237;tulos positivos de FR 41&#44;7 UI&#47;mL &#40;VR &#60; 20 UI&#47;mL&#41; &#40;paciente&#160;1&#41;&#59; A Lp&#40;a&#41; encontrava&#8208;se elevada em tr&#234;s pacientes 107&#44; 75 e 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;VR &#60; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; &#40;pacientes&#160;2&#44;&#160;4&#160;e&#160;6&#44; respectivamente&#41;&#46; O exame histol&#243;gico das bi&#243;psias de pele revelou achados similares em todos os esp&#233;cimes&#58; epiderme sem altera&#231;&#245;es dignas de nota&#59; infiltrado linfoc&#237;tico ao redor de pequenas art&#233;rias na derme reticular profunda e subcut&#226;neo superficial e um anel hialinizado de fibrina na luz dos vasos em todos os sete casos&#44; al&#233;m de oclus&#227;o do l&#250;men vascular por trombo de fibrina em duas pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; A composi&#231;&#227;o muscular dos vasos de m&#233;dio calibre foi mais bem visualizada com a colora&#231;&#227;o de resorcina&#8208;fucsina&#44; que revelou uma l&#226;mina el&#225;stica interna focalmente descont&#237;nua e interrompida em uma paciente&#46; Neutr&#243;filos n&#227;o estavam presentes&#46; Imunofluoresc&#234;ncia direta foi feita em tr&#234;s pacientes e apenas em uma revelou dep&#243;sitos de C3 na parede de vasos d&#233;rmicos&#46; Estudo de imuno&#8208;histoqu&#237;mica com anticorpos anti&#8208;BCG foi conduzido em tr&#234;s pacientes e estava normal&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">O tratamento medicamentoso usado isolado ou em combina&#231;&#227;o incluiu &#225;cido acetilsalic&#237;lico em todas as sete pacientes&#44; al&#233;m de pentoxifilina e hidroxicloroquina em uma paciente&#46; O seguimento variou de&#160;18&#8208;151&#160;meses&#44; com dura&#231;&#227;o m&#233;dia de&#160;79&#160;meses&#46; Durante esse per&#237;odo&#44; nenhuma paciente mostrou resolu&#231;&#227;o das les&#245;es&#44; nem progrediu para vasculite sist&#234;mica&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">Os resultados do presente estudo est&#227;o de acordo com a literatura revisada&#46; A principal apresenta&#231;&#227;o cl&#237;nica da AML ocorreu sob a forma de m&#225;culas hiperpigmentadas cr&#244;nicas e persistentes&#44; embora outros achados dermatol&#243;gicos&#44; como livedo racemoso&#44; placas eritematosas e indura&#231;&#245;es subcut&#226;neas sutis&#44; tenham sido detectados&#46; Houve predile&#231;&#227;o pelas extremidades inferiores&#46; No entanto&#44; a frequ&#234;ncia de sintomas reportados foi maior nesta s&#233;rie do que em relatos pr&#233;vios&#46; As caracter&#237;sticas cl&#237;nicas dos pacientes com AML j&#225; publicados na literatura&#44; bem como seus achados laboratoriais&#44; est&#227;o resumidos no material suplementar &#40;<a class="elsevierStyleCrossRef" href="#sec0070">Ap&#234;ndice A</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Houve relatos isolados de casos associando AML &#224; infec&#231;&#227;o por v&#237;rus do HIV ou hepatite&#160;B&#44; artrite reumatoide e l&#250;pus eritematoso discoide e a medica&#231;&#245;es como minociclina e tabaco&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#44;12&#44;15&#8211;18</span></a> V&#225;rias altera&#231;&#245;es laboratoriais t&#234;m sido descritas&#44; mas pela primeira vez descrevemos n&#237;veis elevados de Lp&#40;a&#41; em tr&#234;s pacientes diagnosticados com AML&#46; A Lp&#40;a&#41; est&#225; envolvida na modula&#231;&#227;o da agrega&#231;&#227;o plaquet&#225;ria&#44; no recrutamento de c&#233;lulas inflamat&#243;rias e na indu&#231;&#227;o do remodelamento vascular&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> De modo similar&#44; nosso grupo de estudos descobriu n&#237;veis elevados de Lp&#40;a&#41; em pacientes com vasculopatia livedoide&#44; uma vasculopatia trombo&#8208;oclusiva de vasos d&#233;rmicos que usualmente se apresenta com p&#250;rpuras reticuladas recorrentes nas pernas e nos p&#233;s&#44; as quais&#44; por sua vez&#44; levam a les&#245;es ulceradas e cicatrizes estelares atr&#243;ficas e de cor marfim&#44; conhecidas como atrofia branca&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Duas pacientes nesta s&#233;rie tinham hist&#243;ria de migr&#226;nea com aura&#46; Em casos semelhantes&#44; &#233; essencial excluir a s&#237;ndrome de Sneddon&#44; uma vasculopatia tromb&#243;tica n&#227;o inflamat&#243;ria caracterizada pela associa&#231;&#227;o de livedo&#44; que acomete tronco e&#47;ou gl&#250;teos&#44; e eventos isqu&#234;micos cerebrovasculares&#44; j&#225; que metade desses pacientes apresenta tal padr&#227;o de cefaleia&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> Ambas apresentavam duas bi&#243;psias de pele cada em diferentes ocasi&#245;es e seguimento superior a cinco anos&#46; Uma delas apresentou tamb&#233;m t&#237;tulos positivos de anticorpos aCL de classe IgM em testes repetidos com pelo menos&#160;12&#160;semanas de intervalo&#46; Embora n&#227;o tivesse hist&#243;ria de trombocitopenia&#44; eventos tromb&#243;ticos no passado ou manifesta&#231;&#245;es obst&#233;tricas&#44; procuramos descartar s&#237;ndrome antifosfol&#237;pide&#46; Classicamente&#44; os achados histol&#243;gicos nessa s&#237;ndrome s&#227;o de trombose sem evid&#234;ncia significativa de inflama&#231;&#227;o na parede vascular&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Achados histol&#243;gicos t&#237;picos foram vistos em todas as bi&#243;psias de pele feitas neste grupo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; inclusive estudos de imunofluoresc&#234;ncia direta negativos para dep&#243;sitos de IgM&#44; IgG e IgA na membrana basal e em torno dos vasos&#46; Como relatado previamente e de maneira contr&#225;ria &#224; descri&#231;&#227;o original&#44; em alguns casos a colora&#231;&#227;o para tecidos el&#225;sticos revelou uma disrup&#231;&#227;o na l&#226;mina el&#225;stica interna&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;23&#44;24</span></a> Um dos diagn&#243;sticos diferenciais histol&#243;gicos da AML &#233; a doen&#231;a de Buerger &#40;tromboange&#237;te obliterante&#41;&#44; uma doen&#231;a inflamat&#243;ria segmentar n&#227;o ateroscler&#243;tica que frequentemente afeta art&#233;rias de pequeno e m&#233;dio calibre&#44; veias e nervos nas extremidades superiores e inferiores&#46; Hist&#243;ria atual ou pr&#233;via de tabagismo &#233; imprescind&#237;vel para o diagn&#243;stico&#44; uma vez que se trata do principal agente associado &#224; doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">25&#44;26</span></a> Apesar de uma de nossas pacientes apresentar antecedente de uso de tabaco&#44; desfavorece esse diagn&#243;stico a aus&#234;ncia de mudan&#231;as na colora&#231;&#227;o da pele e na temperatura dos membros acometidos&#44; ulcera&#231;&#245;es isqu&#234;micas e gangrena&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Enquanto isso&#44; les&#245;es agudas de PAN&#8208;C&#44; a variante da poliarterite nodosa limitada &#224; pele&#44; exibem vasculite necrotizante fibrinoide de art&#233;rias de pequeno e m&#233;dio calibre localizadas na jun&#231;&#227;o derme&#8208;subcut&#226;neo com um infiltrado predominantemente composto de c&#233;lulas polimorfonucleares&#46; Clinicamente&#44; PAN&#8208;C se apresenta com maior frequ&#234;ncia como n&#243;dulos subcut&#226;neos dolorosos e &#250;lceras nos membros inferiores&#44; geralmente em associa&#231;&#227;o com livedo racemoso&#46; Sintomas extracut&#226;neos&#44; como neuropatia perif&#233;rica&#44; mialgia e artralgia&#44; s&#227;o limitados &#224; mesma &#225;rea em que est&#227;o situadas as les&#245;es cut&#226;neas&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">27&#8211;29</span></a> Caracter&#237;sticas relevantes de ambas AML e PAN&#8208;C est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Diversos tratamentos para AML t&#234;m sido relatados com resultados vari&#225;veis&#46; Esteroides t&#243;picos j&#225; foram tentados sem melhoria cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;24&#44;30</span></a> Al&#233;m disso&#44; n&#227;o houve resposta a baixas doses de aspirina&#44; clopidogrel e varfarina&#46; De fato&#44; em dois casos as les&#245;es progrediram mesmo durante o uso da medica&#231;&#227;o&#46; At&#233; 80&#37; de melhoria no aspecto das les&#245;es foi demostrado durante o uso de dapsona 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia e resolu&#231;&#227;o total ap&#243;s o uso de prednisona em baixas doses&#44; metotrexato&#44; bem como de colchicina&#44; embora a dura&#231;&#227;o do seguimento relatada nesse &#250;ltimo caso tenha sido de apenas oito meses&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">30&#8211;32</span></a> Os autores escolheram &#225;cido acetilsalic&#237;lico e pentoxifilina como tratamento de primeira linha para a AML&#46; Em quatro pacientes&#44; a hidroxicloroquina foi acrescentada por persist&#234;ncia dos sintomas ou por extens&#227;o das les&#245;es para segmentos al&#233;m das pernas e elas se mantiveram est&#225;veis&#46; N&#227;o se observou regress&#227;o das les&#245;es cut&#226;neas maculares&#44; nem surgimento de &#250;lceras necr&#243;ticas&#44; dano neurol&#243;gico ou manifesta&#231;&#245;es sist&#234;micas&#46; Do conhecimento dos autores&#44; a dura&#231;&#227;o do seguimento nesta s&#233;rie &#233; a maior j&#225; relatada na literatura&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudo descreve sete pacientes cuja apresenta&#231;&#227;o cl&#237;nica e histopatol&#243;gica &#233; compat&#237;vel com AML&#46; Dada a sobreposi&#231;&#227;o de aspectos cl&#237;nicos&#44; existe um debate em curso se a AML poderia ou n&#227;o ser considerada uma forma precursora ou indolente de PAN&#8208;C&#46; Levando em considera&#231;&#227;o a exist&#234;ncia de uma j&#225; bem estudada transi&#231;&#227;o de um infiltrado predominantemente neutrof&#237;lico para um infiltrado linfoc&#237;tico nos estados subagudos e reparativos de PAN&#8208;C&#44; assim como o fato de que alguns pacientes com AML podem exibir caracter&#237;sticas histol&#243;gicas intermedi&#225;rias&#44; como necrose fibrinoide e disrup&#231;&#227;o da l&#226;mina el&#225;stica interna&#44; os autores acreditam ser razo&#225;vel consider&#225;&#8208;las como pertencentes a um mesmo espectro de doen&#231;a&#46; Prop&#245;e&#8208;se que a AML possa representar uma resposta imune menos agressiva ao componente arterial dos vasos de m&#233;dio calibre&#44; a qual &#233; insuficiente para provocar ulcera&#231;&#245;es&#44; cicatrizes ou sintomas inconvenientes na maioria das vezes&#46; Ao longo do tempo&#44; mais pesquisas sobre sua etiopatog&#234;nese podem elucidar se de fato existe alguma rela&#231;&#227;o entre ambas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0090" class="elsevierStylePara elsevierViewall">Thamara Cristiane Alves Batista Morita&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Gabriela Franco Sturzeneker Tr&#233;s&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Paulo Ricardo Criado&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflitos de interesse</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A arterite macular linfoc&#237;tica apresenta&#8208;se mais comumente como m&#225;culas hiperpigmentadas nos membros inferiores&#46; A patog&#234;nese da doen&#231;a ainda &#233; incerta e h&#225; uma discuss&#227;o em curso se ela de fato representa uma nova vasculite cut&#226;nea ou se trata de uma forma indolente de poliarterite nodosa cut&#226;nea&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever achados cl&#237;nicos&#44; histopatol&#243;gicos e laboratoriais de pacientes que receberam o diagn&#243;stico de arterite macular linfoc&#237;tica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi conduzida uma pesquisa retrospectiva&#44; em que foram revistos os casos seguidos na Cl&#237;nica de Vasculites da Divis&#227;o de Dermatologia&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; entre 2005 e 2017&#46; Sete pacientes foram inclu&#237;dos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Todos os pacientes eram do sexo feminino&#44; entre 9&#8208;46 anos&#44; e tinham m&#225;culas hiperpigmentadas principalmente nas pernas&#46; Tr&#234;s pacientes relataram sintomas&#46; As bi&#243;psias de pele evidenciavam infiltrados predominantemente linfoc&#237;ticos que acometiam arter&#237;olas da jun&#231;&#227;o derme&#8208;subcut&#226;neo&#44; bem como um t&#237;pico anel de fibrina luminal&#46; Nenhum paciente desenvolveu &#250;lceras necr&#243;ticas&#44; dano neurol&#243;gico ou manifesta&#231;&#245;es sist&#234;micas&#46; O seguimento variou de&#160;18 a 151&#160;meses&#44; com dura&#231;&#227;o m&#233;dia de&#160;79&#160;meses&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pequena amostra de pacientes e desenho retrospectivo e n&#227;o controlado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De nosso melhor conhecimento&#44; esta s&#233;rie de casos apresenta a maior dura&#231;&#227;o de seguimento j&#225; relatada&#46; Durante esse per&#237;odo&#44; nenhum dos pacientes mostrou resolu&#231;&#227;o das les&#245;es nem progress&#227;o para vasculite sist&#234;mica&#46; Similaridades entre os achados das bi&#243;psias de pele d&#227;o apoio &#224; hip&#243;tese de que a arterite macular linfoc&#237;tica &#233; uma forma benigna&#44; incompleta e menos agressiva de poliarterite nodosa cut&#226;nea&#46;</p></span>"
        "secciones" => array:6 [
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            "identificador" => "abst0005"
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            "titulo" => "Resultados"
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          4 => array:2 [
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            "titulo" => "Limita&#231;&#245;es do estudo"
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          5 => array:2 [
            "identificador" => "abst0030"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Morita TCAB&#44; Tr&#233;s GFS&#44; Criado PR&#46; Is macular lymphocytic arteritis limited to the skin&#63; Long&#8208;term follow&#8208;up of seven patients&#46; An Bras Dermatol&#46; 2020&#59;95&#58;32&#8211;9&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
      ]
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          0 => array:4 [
            "apendice" => "<p id="par0430" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
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        ]
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      0 => array:7 [
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        "etiqueta" => "Figura 1"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Apresenta&#231;&#227;o cl&#237;nica da arterite macular linfoc&#237;tica nos membros inferiores&#46; <span class="elsevierStyleBold">A&#44;</span> M&#250;ltiplas m&#225;culas lineares e por vezes circulares&#44; veias varicosas e uma cicatriz de bi&#243;psia na panturrilha direita&#59; <span class="elsevierStyleBold">B&#44;</span> M&#225;culas redondas e bem definidas distribu&#237;das nos membros&#59; <span class="elsevierStyleBold">C&#44;</span> M&#225;culas hipercr&#244;micas bem definidas&#44; algumas das quais levemente infiltradas &#224; palpa&#231;&#227;o e uma cicatriz de bi&#243;psia na panturrilha esquerda&#59; <span class="elsevierStyleBold">D&#44;</span> M&#225;culas eritematosas em padr&#227;o reticulado associadas a livedo racemoso&#46;</p>"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
            "Alto" => 980
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Exame histol&#243;gico de bi&#243;psia de les&#245;es compat&#237;veis com arterite macular linfoc&#237;tica nas pernas&#46; <span class="elsevierStyleBold">A&#44;</span> Uma art&#233;ria cut&#226;nea de pequeno calibre na derme profunda circundada e infiltrada por linf&#243;citos &#40;Hematoxilina &#38; eosina&#44;&#160;200&#215;&#41;&#59; <span class="elsevierStyleBold">B&#44;</span> Estreitamento da luz do vaso por espessamento subintimal &#40;Hematoxilina &#38; eosina&#44;&#160;100&#215;&#41;&#59; <span class="elsevierStyleBold">C&#44;</span> Presen&#231;a de inflama&#231;&#227;o densa que envolve as paredes de uma arter&#237;ola no subcut&#226;neo superficial &#40;Hematoxilina &#38; eosina&#44;&#160;200&#215;&#41;&#59; <span class="elsevierStyleBold">D&#44;</span> Vaso hipod&#233;rmico com trombo organizado&#160;&#40;Hematoxilina &#38; eosina&#44;&#160;200x&#41;&#46;</p>"
        ]
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2886
            "Ancho" => 2167
            "Tamanyo" => 916846
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Achados histol&#243;gicos t&#237;picos da arterite macular linfoc&#237;tica&#46; <span class="elsevierStyleBold">A&#44;</span> Art&#233;ria dermo&#8208;hipod&#233;rmica circundada por infiltrado linfoc&#237;tico denso que permeia sua parede&#59; <span class="elsevierStyleBold">B&#44;</span> Maior amplia&#231;&#227;o da vista do vaso anterior&#59; <span class="elsevierStyleBold">C&#44;</span> Um anel hialino conc&#234;ntrico &#233; mostrado &#40;Hematoxilina &#38; eosina&#44; 400&#215;&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AAS&#44; &#225;cido acetilsalic&#237;lico&#59; F&#44; feminino&#59; HCQ&#44; hidroxicloroquina&#59; MMII&#44; membros inferiores&#59; MMSS&#44; membros superiores&#59; PTX&#44; pentoxifilina&#59; T&#44; tronco&#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=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso n&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&#47;idade ao in&#237;cio &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etnia&#47;cor da pele&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hist&#243;ria m&#233;dica pr&#233;via&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Morfologia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o da doen&#231;a antes do diagn&#243;stico &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas locais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seguimento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Migr&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Artralgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; placas eritematosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#43;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Migr&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#43;MMSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; indura&#231;&#245;es subcut&#226;neas sutis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ex&#8208;tabagista&#44; tuberculose pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&#44; parestesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dados epidemiol&#243;gicos e caracter&#237;sticas cl&#237;nicas de sete pacientes diagnosticados com arterite macular linfoc&#237;tica</p>"
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        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">MMII&#44; membros inferiores&#59; MMSS&#44; membros superiores&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Arterite macular linfoc&#237;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Poliarterite nodosa cut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspectos cl&#237;nicos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas redondas&#44; lineares ou reticulares&#44; e placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#250;rpuras palp&#225;veis&#44; n&#243;dulos subcut&#226;neos dolorosos&#44; &#250;lceras recorrentes e&#44; raramente&#44; gangrena e necrose digital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Les&#245;es s&#227;o assintom&#225;ticas&#44; minimamente dolorosas ou pruriginosasSintomas sist&#234;micos &#40;infartos testiculares e neuropatias&#41; t&#234;m sido descritos raramente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Envolvimento extracut&#226;neo pode se manifestar como mialgia&#44; neuropatia perif&#233;rica e artralgia&#44; limitadas a mesma &#225;rea em que se encontram as les&#245;es cut&#226;neas&#44; por vezes acompanhada de febre e perda de peso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#160;&#62;&#160;MMSS&#160;&#62; tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII &#62; MMSS &#62; tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspectos histol&#243;gicos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infiltrado linfoc&#237;tico na parede muscular de pequenas art&#233;rias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasculite leucocitocl&#225;stica que acomete as paredes de vasos de m&#233;dio calibre e arter&#237;olas dos septos das por&#231;&#245;es superiores do tecido subcut&#226;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos s&#227;o ausentes ou escassos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrose fibrinoide associada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrose fibrinoide associada nas les&#245;es ativas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estreitamento vari&#225;vel do l&#250;men vascular por deposi&#231;&#227;o conc&#234;ntrica de fibrina e prolifera&#231;&#227;o intimal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tardiamente no processo da doen&#231;a&#44; o infiltrado &#233; predominantemente composto de linf&#243;citos e histi&#243;citos e a neoangiog&#234;nese se torna aparente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aus&#234;ncia de disrup&#231;&#227;o da l&#226;mina el&#225;stica interna na maioria dos casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">L&#226;mina el&#225;stica fragmentada e descont&#237;nua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Imunofluoresc&#234;ncia direta negativa para dep&#243;sitos perivasculares ou em membrana basal de IgG&#44; IgM&#44; IgA e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Imunofluoresc&#234;ncia direta pode fornecer resultados positivos para IgM e C3&#44; tanto isoladamente quanto de forma combinada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Curso cr&#244;nico e benigno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Curso cr&#244;nico&#44; progress&#227;o de poliarterite nodosa cut&#226;nea para poliarterite nodosa generalizada raramente ocorre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Investigação
Seria a arterite macular linfocítica limitada à pele? Seguimento prolongado de sete pacientes
Thâmara Cristiane Alves Batista Moritaa,
Corresponding author
thamaramorita@usp.br

Autor para correspondência.
, Gabriela Franco Sturzeneker Trésa, Paulo Ricardo Criadoa,b
a Departamento de Dermatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
b Faculdade de Medicina do ABC, Santo André, SP, Brasil
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embora haja relatos de ulcera&#231;&#227;o cut&#226;nea&#44; infartos testiculares e neuropatia&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ao exame histol&#243;gico&#44; a AML mostra um denso infiltrado de c&#233;lulas mononucleares na parede muscular das arter&#237;olas da jun&#231;&#227;o derme&#8208;subcut&#226;neo&#44; com estreitamento vari&#225;vel de seu l&#250;men por um t&#237;pico anel hialinizado de fibrina&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">12&#44;13</span></a> Alguns autores preferem se referir a ela como &#8220;arterite trombof&#237;lica linfoc&#237;tica&#8221; para enfatizar o suposto mecanismo patog&#234;nico associado a essa entidade&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> Na verdade&#44; &#233; question&#225;vel se a AML tem caracter&#237;sticas definidoras suficientes para ser considerada uma vasculite distinta da poliarterite nodosa cut&#226;nea &#40;PAN&#8208;C&#41;&#44; uma arterite necrotizante de vasos de m&#233;dio calibre com infiltrado predominantemente polimorfonuclear&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nosso objetivo foi avaliar retrospectivamente uma s&#233;rie de pacientes com diagn&#243;stico de AML&#44; a fim de analisar suas caracter&#237;sticas cl&#237;nicas&#44; histopatol&#243;gicas e laboratoriais&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica da Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; e todos os participantes preencheram o termo de consentimento informado&#46; Foram inclu&#237;dos sete pacientes diagnosticados com AML no Ambulat&#243;rio de Vasculites da Divis&#227;o de Dermatologia entre fevereiro de&#160;2005 e setembro de&#160;2017&#46; 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ultrassonografia com <span class="elsevierStyleItalic">Doppler</span> do sistema venoso&#44; em dois pacientes &#40;pacientes&#160;5&#160;e&#160;6&#41;&#59; e eletroneuromiografia&#44; em um paciente &#40;paciente&#160;6&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para a revis&#227;o da literatura&#44; em setembro de&#160;2018 fizemos buscas nas bases de dados <span class="elsevierStyleItalic">PubMed&#44; Web of Science e Scopus</span> com os termos &#8220;arterite macular linfoc&#237;tica&#8221;&#44; &#8220;arterite macular&#8221; ou &#8220;arterite trombof&#237;lica linfoc&#237;tica&#8221;&#46; Artigos relevantes foram identificados por inspe&#231;&#227;o manual das listas de refer&#234;ncias&#46; Dois investigadores avaliaram t&#237;tulos e resumos de maneira independente para determinar o potencial de inclus&#227;o dos trabalhos&#46; Ao todo&#44; 34&#160;artigos foram analisados&#46; Ap&#243;s excluir um estudo com dados incompletos&#44; foram resumidos os resultados de&#160;23&#160;artigos identificados como relato ou s&#233;rie de casos&#46; Eles ser&#227;o discutidos posteriormente neste artigo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os pacientes nesta s&#233;rie eram mulheres&#46; Elas foram classificadas de acordo com etnia&#47;cor da pele&#46; Seis eram brancas e uma era negra&#46; A idade variou de 9 a 46 anos&#44; com m&#233;dia ao diagn&#243;stico de 26&#44;71 &#40;DP &#61; 12&#44;44&#41;&#46; A dura&#231;&#227;o da doen&#231;a antes do diagn&#243;stico variou de 6 a 96 meses&#44; com m&#233;dia de 34&#44;42 &#40;DP &#61; 32&#44;88&#41;&#46; Hiperpigmenta&#231;&#227;o reticulada persistente foi encontrada em todas as pacientes&#44; seguida por livedo racemoso &#40;duas pacientes&#41; e&#44; em igual frequ&#234;ncia&#44; placas eritematosas e indura&#231;&#245;es subcut&#226;neas sutis &#40;uma paciente cada&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; N&#227;o houve evid&#234;ncia de ulcera&#231;&#227;o&#44; atrofia branca&#44; n&#243;dulos ou p&#250;rpura palp&#225;vel&#46; As pernas foram afetadas em todas as pacientes&#44; enquanto os bra&#231;os e o tronco em uma paciente cada&#46; As les&#245;es se apresentaram simetricamente quando acometeram as pernas&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Sintomas referidos no mesmo segmento corporal onde se encontravam as les&#245;es cut&#226;neas foram encontrados em tr&#234;s pacientes&#46; Uma delas &#40;paciente&#160;6&#41; queixou&#8208;se de parestesia e dor&#59; por essa raz&#227;o&#44; uma eletroneuromiografia foi feita&#44; mas n&#227;o apresentou altera&#231;&#245;es&#44; enquanto uma ultrassonografia do sistema venoso dos membros inferiores revelou insufici&#234;ncia venosa cr&#244;nica devido a um refluxo prim&#225;rio da safena magna na perna esquerda&#46; Estudos de ultrassonografia com <span class="elsevierStyleItalic">Doppler</span> da aorta abdominal&#44; art&#233;rias il&#237;acas e renais das pacientes 4&#44; 5 e 6 resultaram normais&#44; assim como uma ultrassonografia do sistema venoso dos membros inferiores da paciente 5&#46; Nenhuma das pacientes tinha hist&#243;ria de trombose arterial ou venosa&#46; Uma das pacientes era ex&#8208;tabagista&#44; diagnosticada e tratada para tuberculose pulmonar quatro anos antes da admiss&#227;o&#46; Esfrega&#231;o para baciloscopia do escarro e tomografia computadorizada do t&#243;rax n&#227;o mostraram sinais de doen&#231;a ativa&#46; Duas pacientes foram diagnosticadas com migr&#226;nea e foram acompanhadas pela equipe de neurologia do hospital&#46; Dados demogr&#225;ficos&#44; achados histopatol&#243;gicos&#44; tratamento e dura&#231;&#227;o do seguimento est&#227;o representados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o laboratorial mostrou poucas altera&#231;&#245;es&#44; como baixa atividade de prote&#237;na&#160;S 28&#37; &#40;VR 55&#37;&#8208;160&#37;&#41; &#40;paciente&#160;3&#41;&#59; FAN de 1&#58;80 com padr&#227;o nuclear pontilhado fino e n&#237;vel de fibrinog&#234;nio ligeiramente elevado 406<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;VR 150&#8208;400<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; &#40;paciente&#160;5&#41;&#46; Duas pacientes apresentaram t&#237;tulos significativamente positivos de anticorpos aCL IgM em testes repetidos &#40;pacientes&#160;1&#160;e&#160;3&#41;&#44; uma das quais apresentava tamb&#233;m t&#237;tulos positivos de FR 41&#44;7 UI&#47;mL &#40;VR &#60; 20 UI&#47;mL&#41; &#40;paciente&#160;1&#41;&#59; A Lp&#40;a&#41; encontrava&#8208;se elevada em tr&#234;s pacientes 107&#44; 75 e 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;VR &#60; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; &#40;pacientes&#160;2&#44;&#160;4&#160;e&#160;6&#44; respectivamente&#41;&#46; O exame histol&#243;gico das bi&#243;psias de pele revelou achados similares em todos os esp&#233;cimes&#58; epiderme sem altera&#231;&#245;es dignas de nota&#59; infiltrado linfoc&#237;tico ao redor de pequenas art&#233;rias na derme reticular profunda e subcut&#226;neo superficial e um anel hialinizado de fibrina na luz dos vasos em todos os sete casos&#44; al&#233;m de oclus&#227;o do l&#250;men vascular por trombo de fibrina em duas pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; A composi&#231;&#227;o muscular dos vasos de m&#233;dio calibre foi mais bem visualizada com a colora&#231;&#227;o de resorcina&#8208;fucsina&#44; que revelou uma l&#226;mina el&#225;stica interna focalmente descont&#237;nua e interrompida em uma paciente&#46; Neutr&#243;filos n&#227;o estavam presentes&#46; Imunofluoresc&#234;ncia direta foi feita em tr&#234;s pacientes e apenas em uma revelou dep&#243;sitos de C3 na parede de vasos d&#233;rmicos&#46; Estudo de imuno&#8208;histoqu&#237;mica com anticorpos anti&#8208;BCG foi conduzido em tr&#234;s pacientes e estava normal&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">O tratamento medicamentoso usado isolado ou em combina&#231;&#227;o incluiu &#225;cido acetilsalic&#237;lico em todas as sete pacientes&#44; al&#233;m de pentoxifilina e hidroxicloroquina em uma paciente&#46; O seguimento variou de&#160;18&#8208;151&#160;meses&#44; com dura&#231;&#227;o m&#233;dia de&#160;79&#160;meses&#46; Durante esse per&#237;odo&#44; nenhuma paciente mostrou resolu&#231;&#227;o das les&#245;es&#44; nem progrediu para vasculite sist&#234;mica&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">Os resultados do presente estudo est&#227;o de acordo com a literatura revisada&#46; A principal apresenta&#231;&#227;o cl&#237;nica da AML ocorreu sob a forma de m&#225;culas hiperpigmentadas cr&#244;nicas e persistentes&#44; embora outros achados dermatol&#243;gicos&#44; como livedo racemoso&#44; placas eritematosas e indura&#231;&#245;es subcut&#226;neas sutis&#44; tenham sido detectados&#46; Houve predile&#231;&#227;o pelas extremidades inferiores&#46; No entanto&#44; a frequ&#234;ncia de sintomas reportados foi maior nesta s&#233;rie do que em relatos pr&#233;vios&#46; As caracter&#237;sticas cl&#237;nicas dos pacientes com AML j&#225; publicados na literatura&#44; bem como seus achados laboratoriais&#44; est&#227;o resumidos no material suplementar &#40;<a class="elsevierStyleCrossRef" href="#sec0070">Ap&#234;ndice A</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Houve relatos isolados de casos associando AML &#224; infec&#231;&#227;o por v&#237;rus do HIV ou hepatite&#160;B&#44; artrite reumatoide e l&#250;pus eritematoso discoide e a medica&#231;&#245;es como minociclina e tabaco&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#44;12&#44;15&#8211;18</span></a> V&#225;rias altera&#231;&#245;es laboratoriais t&#234;m sido descritas&#44; mas pela primeira vez descrevemos n&#237;veis elevados de Lp&#40;a&#41; em tr&#234;s pacientes diagnosticados com AML&#46; A Lp&#40;a&#41; est&#225; envolvida na modula&#231;&#227;o da agrega&#231;&#227;o plaquet&#225;ria&#44; no recrutamento de c&#233;lulas inflamat&#243;rias e na indu&#231;&#227;o do remodelamento vascular&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> De modo similar&#44; nosso grupo de estudos descobriu n&#237;veis elevados de Lp&#40;a&#41; em pacientes com vasculopatia livedoide&#44; uma vasculopatia trombo&#8208;oclusiva de vasos d&#233;rmicos que usualmente se apresenta com p&#250;rpuras reticuladas recorrentes nas pernas e nos p&#233;s&#44; as quais&#44; por sua vez&#44; levam a les&#245;es ulceradas e cicatrizes estelares atr&#243;ficas e de cor marfim&#44; conhecidas como atrofia branca&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Duas pacientes nesta s&#233;rie tinham hist&#243;ria de migr&#226;nea com aura&#46; Em casos semelhantes&#44; &#233; essencial excluir a s&#237;ndrome de Sneddon&#44; uma vasculopatia tromb&#243;tica n&#227;o inflamat&#243;ria caracterizada pela associa&#231;&#227;o de livedo&#44; que acomete tronco e&#47;ou gl&#250;teos&#44; e eventos isqu&#234;micos cerebrovasculares&#44; j&#225; que metade desses pacientes apresenta tal padr&#227;o de cefaleia&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> Ambas apresentavam duas bi&#243;psias de pele cada em diferentes ocasi&#245;es e seguimento superior a cinco anos&#46; Uma delas apresentou tamb&#233;m t&#237;tulos positivos de anticorpos aCL de classe IgM em testes repetidos com pelo menos&#160;12&#160;semanas de intervalo&#46; Embora n&#227;o tivesse hist&#243;ria de trombocitopenia&#44; eventos tromb&#243;ticos no passado ou manifesta&#231;&#245;es obst&#233;tricas&#44; procuramos descartar s&#237;ndrome antifosfol&#237;pide&#46; Classicamente&#44; os achados histol&#243;gicos nessa s&#237;ndrome s&#227;o de trombose sem evid&#234;ncia significativa de inflama&#231;&#227;o na parede vascular&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Achados histol&#243;gicos t&#237;picos foram vistos em todas as bi&#243;psias de pele feitas neste grupo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; inclusive estudos de imunofluoresc&#234;ncia direta negativos para dep&#243;sitos de IgM&#44; IgG e IgA na membrana basal e em torno dos vasos&#46; Como relatado previamente e de maneira contr&#225;ria &#224; descri&#231;&#227;o original&#44; em alguns casos a colora&#231;&#227;o para tecidos el&#225;sticos revelou uma disrup&#231;&#227;o na l&#226;mina el&#225;stica interna&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;23&#44;24</span></a> Um dos diagn&#243;sticos diferenciais histol&#243;gicos da AML &#233; a doen&#231;a de Buerger &#40;tromboange&#237;te obliterante&#41;&#44; uma doen&#231;a inflamat&#243;ria segmentar n&#227;o ateroscler&#243;tica que frequentemente afeta art&#233;rias de pequeno e m&#233;dio calibre&#44; veias e nervos nas extremidades superiores e inferiores&#46; Hist&#243;ria atual ou pr&#233;via de tabagismo &#233; imprescind&#237;vel para o diagn&#243;stico&#44; uma vez que se trata do principal agente associado &#224; doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">25&#44;26</span></a> Apesar de uma de nossas pacientes apresentar antecedente de uso de tabaco&#44; desfavorece esse diagn&#243;stico a aus&#234;ncia de mudan&#231;as na colora&#231;&#227;o da pele e na temperatura dos membros acometidos&#44; ulcera&#231;&#245;es isqu&#234;micas e gangrena&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Enquanto isso&#44; les&#245;es agudas de PAN&#8208;C&#44; a variante da poliarterite nodosa limitada &#224; pele&#44; exibem vasculite necrotizante fibrinoide de art&#233;rias de pequeno e m&#233;dio calibre localizadas na jun&#231;&#227;o derme&#8208;subcut&#226;neo com um infiltrado predominantemente composto de c&#233;lulas polimorfonucleares&#46; Clinicamente&#44; PAN&#8208;C se apresenta com maior frequ&#234;ncia como n&#243;dulos subcut&#226;neos dolorosos e &#250;lceras nos membros inferiores&#44; geralmente em associa&#231;&#227;o com livedo racemoso&#46; Sintomas extracut&#226;neos&#44; como neuropatia perif&#233;rica&#44; mialgia e artralgia&#44; s&#227;o limitados &#224; mesma &#225;rea em que est&#227;o situadas as les&#245;es cut&#226;neas&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">27&#8211;29</span></a> Caracter&#237;sticas relevantes de ambas AML e PAN&#8208;C est&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Diversos tratamentos para AML t&#234;m sido relatados com resultados vari&#225;veis&#46; Esteroides t&#243;picos j&#225; foram tentados sem melhoria cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;24&#44;30</span></a> Al&#233;m disso&#44; n&#227;o houve resposta a baixas doses de aspirina&#44; clopidogrel e varfarina&#46; De fato&#44; em dois casos as les&#245;es progrediram mesmo durante o uso da medica&#231;&#227;o&#46; At&#233; 80&#37; de melhoria no aspecto das les&#245;es foi demostrado durante o uso de dapsona 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia e resolu&#231;&#227;o total ap&#243;s o uso de prednisona em baixas doses&#44; metotrexato&#44; bem como de colchicina&#44; embora a dura&#231;&#227;o do seguimento relatada nesse &#250;ltimo caso tenha sido de apenas oito meses&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">30&#8211;32</span></a> Os autores escolheram &#225;cido acetilsalic&#237;lico e pentoxifilina como tratamento de primeira linha para a AML&#46; Em quatro pacientes&#44; a hidroxicloroquina foi acrescentada por persist&#234;ncia dos sintomas ou por extens&#227;o das les&#245;es para segmentos al&#233;m das pernas e elas se mantiveram est&#225;veis&#46; N&#227;o se observou regress&#227;o das les&#245;es cut&#226;neas maculares&#44; nem surgimento de &#250;lceras necr&#243;ticas&#44; dano neurol&#243;gico ou manifesta&#231;&#245;es sist&#234;micas&#46; Do conhecimento dos autores&#44; a dura&#231;&#227;o do seguimento nesta s&#233;rie &#233; a maior j&#225; relatada na literatura&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudo descreve sete pacientes cuja apresenta&#231;&#227;o cl&#237;nica e histopatol&#243;gica &#233; compat&#237;vel com AML&#46; Dada a sobreposi&#231;&#227;o de aspectos cl&#237;nicos&#44; existe um debate em curso se a AML poderia ou n&#227;o ser considerada uma forma precursora ou indolente de PAN&#8208;C&#46; Levando em considera&#231;&#227;o a exist&#234;ncia de uma j&#225; bem estudada transi&#231;&#227;o de um infiltrado predominantemente neutrof&#237;lico para um infiltrado linfoc&#237;tico nos estados subagudos e reparativos de PAN&#8208;C&#44; assim como o fato de que alguns pacientes com AML podem exibir caracter&#237;sticas histol&#243;gicas intermedi&#225;rias&#44; como necrose fibrinoide e disrup&#231;&#227;o da l&#226;mina el&#225;stica interna&#44; os autores acreditam ser razo&#225;vel consider&#225;&#8208;las como pertencentes a um mesmo espectro de doen&#231;a&#46; Prop&#245;e&#8208;se que a AML possa representar uma resposta imune menos agressiva ao componente arterial dos vasos de m&#233;dio calibre&#44; a qual &#233; insuficiente para provocar ulcera&#231;&#245;es&#44; cicatrizes ou sintomas inconvenientes na maioria das vezes&#46; Ao longo do tempo&#44; mais pesquisas sobre sua etiopatog&#234;nese podem elucidar se de fato existe alguma rela&#231;&#227;o entre ambas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0090" class="elsevierStylePara elsevierViewall">Thamara Cristiane Alves Batista Morita&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Gabriela Franco Sturzeneker Tr&#233;s&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Paulo Ricardo Criado&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflitos de interesse</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A arterite macular linfoc&#237;tica apresenta&#8208;se mais comumente como m&#225;culas hiperpigmentadas nos membros inferiores&#46; A patog&#234;nese da doen&#231;a ainda &#233; incerta e h&#225; uma discuss&#227;o em curso se ela de fato representa uma nova vasculite cut&#226;nea ou se trata de uma forma indolente de poliarterite nodosa cut&#226;nea&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descrever achados cl&#237;nicos&#44; histopatol&#243;gicos e laboratoriais de pacientes que receberam o diagn&#243;stico de arterite macular linfoc&#237;tica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi conduzida uma pesquisa retrospectiva&#44; em que foram revistos os casos seguidos na Cl&#237;nica de Vasculites da Divis&#227;o de Dermatologia&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; entre 2005 e 2017&#46; Sete pacientes foram inclu&#237;dos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Todos os pacientes eram do sexo feminino&#44; entre 9&#8208;46 anos&#44; e tinham m&#225;culas hiperpigmentadas principalmente nas pernas&#46; Tr&#234;s pacientes relataram sintomas&#46; As bi&#243;psias de pele evidenciavam infiltrados predominantemente linfoc&#237;ticos que acometiam arter&#237;olas da jun&#231;&#227;o derme&#8208;subcut&#226;neo&#44; bem como um t&#237;pico anel de fibrina luminal&#46; Nenhum paciente desenvolveu &#250;lceras necr&#243;ticas&#44; dano neurol&#243;gico ou manifesta&#231;&#245;es sist&#234;micas&#46; O seguimento variou de&#160;18 a 151&#160;meses&#44; com dura&#231;&#227;o m&#233;dia de&#160;79&#160;meses&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pequena amostra de pacientes e desenho retrospectivo e n&#227;o controlado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De nosso melhor conhecimento&#44; esta s&#233;rie de casos apresenta a maior dura&#231;&#227;o de seguimento j&#225; relatada&#46; Durante esse per&#237;odo&#44; nenhum dos pacientes mostrou resolu&#231;&#227;o das les&#245;es nem progress&#227;o para vasculite sist&#234;mica&#46; Similaridades entre os achados das bi&#243;psias de pele d&#227;o apoio &#224; hip&#243;tese de que a arterite macular linfoc&#237;tica &#233; uma forma benigna&#44; incompleta e menos agressiva de poliarterite nodosa cut&#226;nea&#46;</p></span>"
        "secciones" => array:6 [
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            "identificador" => "abst0005"
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            "titulo" => "Resultados"
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          4 => array:2 [
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            "titulo" => "Limita&#231;&#245;es do estudo"
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          5 => array:2 [
            "identificador" => "abst0030"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Morita TCAB&#44; Tr&#233;s GFS&#44; Criado PR&#46; Is macular lymphocytic arteritis limited to the skin&#63; Long&#8208;term follow&#8208;up of seven patients&#46; An Bras Dermatol&#46; 2020&#59;95&#58;32&#8211;9&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia&#44; Hospital das Cl&#237;nicas&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
      ]
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          0 => array:4 [
            "apendice" => "<p id="par0430" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
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        ]
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      0 => array:7 [
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        "etiqueta" => "Figura 1"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Apresenta&#231;&#227;o cl&#237;nica da arterite macular linfoc&#237;tica nos membros inferiores&#46; <span class="elsevierStyleBold">A&#44;</span> M&#250;ltiplas m&#225;culas lineares e por vezes circulares&#44; veias varicosas e uma cicatriz de bi&#243;psia na panturrilha direita&#59; <span class="elsevierStyleBold">B&#44;</span> M&#225;culas redondas e bem definidas distribu&#237;das nos membros&#59; <span class="elsevierStyleBold">C&#44;</span> M&#225;culas hipercr&#244;micas bem definidas&#44; algumas das quais levemente infiltradas &#224; palpa&#231;&#227;o e uma cicatriz de bi&#243;psia na panturrilha esquerda&#59; <span class="elsevierStyleBold">D&#44;</span> M&#225;culas eritematosas em padr&#227;o reticulado associadas a livedo racemoso&#46;</p>"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
            "Alto" => 980
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Exame histol&#243;gico de bi&#243;psia de les&#245;es compat&#237;veis com arterite macular linfoc&#237;tica nas pernas&#46; <span class="elsevierStyleBold">A&#44;</span> Uma art&#233;ria cut&#226;nea de pequeno calibre na derme profunda circundada e infiltrada por linf&#243;citos &#40;Hematoxilina &#38; eosina&#44;&#160;200&#215;&#41;&#59; <span class="elsevierStyleBold">B&#44;</span> Estreitamento da luz do vaso por espessamento subintimal &#40;Hematoxilina &#38; eosina&#44;&#160;100&#215;&#41;&#59; <span class="elsevierStyleBold">C&#44;</span> Presen&#231;a de inflama&#231;&#227;o densa que envolve as paredes de uma arter&#237;ola no subcut&#226;neo superficial &#40;Hematoxilina &#38; eosina&#44;&#160;200&#215;&#41;&#59; <span class="elsevierStyleBold">D&#44;</span> Vaso hipod&#233;rmico com trombo organizado&#160;&#40;Hematoxilina &#38; eosina&#44;&#160;200x&#41;&#46;</p>"
        ]
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2886
            "Ancho" => 2167
            "Tamanyo" => 916846
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Achados histol&#243;gicos t&#237;picos da arterite macular linfoc&#237;tica&#46; <span class="elsevierStyleBold">A&#44;</span> Art&#233;ria dermo&#8208;hipod&#233;rmica circundada por infiltrado linfoc&#237;tico denso que permeia sua parede&#59; <span class="elsevierStyleBold">B&#44;</span> Maior amplia&#231;&#227;o da vista do vaso anterior&#59; <span class="elsevierStyleBold">C&#44;</span> Um anel hialino conc&#234;ntrico &#233; mostrado &#40;Hematoxilina &#38; eosina&#44; 400&#215;&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AAS&#44; &#225;cido acetilsalic&#237;lico&#59; F&#44; feminino&#59; HCQ&#44; hidroxicloroquina&#59; MMII&#44; membros inferiores&#59; MMSS&#44; membros superiores&#59; PTX&#44; pentoxifilina&#59; T&#44; tronco&#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=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso n&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&#47;idade ao in&#237;cio &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etnia&#47;cor da pele&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hist&#243;ria m&#233;dica pr&#233;via&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Morfologia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dura&#231;&#227;o da doen&#231;a antes do diagn&#243;stico &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas locais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seguimento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Migr&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Artralgia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; placas eritematosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#43;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Migr&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#43;MMSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; indura&#231;&#245;es subcut&#226;neas sutis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&#44; HCQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ex&#8208;tabagista&#44; tuberculose pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor&#44; parestesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#47;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas&#44; livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AAS&#44; PTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dados epidemiol&#243;gicos e caracter&#237;sticas cl&#237;nicas de sete pacientes diagnosticados com arterite macular linfoc&#237;tica</p>"
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        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">MMII&#44; membros inferiores&#59; MMSS&#44; membros superiores&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Arterite macular linfoc&#237;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Poliarterite nodosa cut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspectos cl&#237;nicos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#225;culas hiperpigmentadas redondas&#44; lineares ou reticulares&#44; e placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#250;rpuras palp&#225;veis&#44; n&#243;dulos subcut&#226;neos dolorosos&#44; &#250;lceras recorrentes e&#44; raramente&#44; gangrena e necrose digital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Livedo racemoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Les&#245;es s&#227;o assintom&#225;ticas&#44; minimamente dolorosas ou pruriginosasSintomas sist&#234;micos &#40;infartos testiculares e neuropatias&#41; t&#234;m sido descritos raramente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Envolvimento extracut&#226;neo pode se manifestar como mialgia&#44; neuropatia perif&#233;rica e artralgia&#44; limitadas a mesma &#225;rea em que se encontram as les&#245;es cut&#226;neas&#44; por vezes acompanhada de febre e perda de peso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII&#160;&#62;&#160;MMSS&#160;&#62; tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMII &#62; MMSS &#62; tronco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspectos histol&#243;gicos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infiltrado linfoc&#237;tico na parede muscular de pequenas art&#233;rias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasculite leucocitocl&#225;stica que acomete as paredes de vasos de m&#233;dio calibre e arter&#237;olas dos septos das por&#231;&#245;es superiores do tecido subcut&#226;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos s&#227;o ausentes ou escassos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrose fibrinoide associada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necrose fibrinoide associada nas les&#245;es ativas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estreitamento vari&#225;vel do l&#250;men vascular por deposi&#231;&#227;o conc&#234;ntrica de fibrina e prolifera&#231;&#227;o intimal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tardiamente no processo da doen&#231;a&#44; o infiltrado &#233; predominantemente composto de linf&#243;citos e histi&#243;citos e a neoangiog&#234;nese se torna aparente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aus&#234;ncia de disrup&#231;&#227;o da l&#226;mina el&#225;stica interna na maioria dos casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">L&#226;mina el&#225;stica fragmentada e descont&#237;nua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Imunofluoresc&#234;ncia direta negativa para dep&#243;sitos perivasculares ou em membrana basal de IgG&#44; IgM&#44; IgA e C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Imunofluoresc&#234;ncia direta pode fornecer resultados positivos para IgM e C3&#44; tanto isoladamente quanto de forma combinada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Curso cr&#244;nico e benigno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Curso cr&#244;nico&#44; progress&#227;o de poliarterite nodosa cut&#226;nea para poliarterite nodosa generalizada raramente ocorre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 26662752
Original language: Portuguese
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2022 March 58 67 125
2022 February 48 50 98
2022 January 57 82 139
2021 December 28 57 85
2021 November 48 92 140
2021 October 54 88 142
2021 September 44 61 105
2021 August 49 71 120
2021 July 46 56 102
2021 June 41 66 107
2021 May 59 80 139
2021 April 106 209 315
2021 March 71 64 135
2021 February 24 24 48
2021 January 34 26 60
2020 December 36 28 64
2020 November 28 23 51
2020 October 38 22 60
2020 September 17 12 29
2020 August 7 7 14
2020 July 14 13 27
2020 June 18 13 31
2020 May 22 12 34
2020 April 2 0 2
2020 March 0 2 2
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