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doen&#231;a viral incomum em adultos como resultado de imunidade cruzada com outros enterov&#237;rus e mem&#243;ria imunol&#243;gica&#46; Entretanto&#44; um aumento de casos com apresenta&#231;&#227;o cl&#237;nica at&#237;pica e um diagn&#243;stico dif&#237;cil foram observados nessa faixa et&#225;ria nos &#250;ltimos anos&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diferente das publica&#231;&#245;es internacionais&#44; os casos descritos no presente relato foram causados pelo Coxsackiev&#237;rus B1&#8208;B6&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As manifesta&#231;&#245;es cl&#237;nicas da DMPB em adultos s&#227;o diferentes das manifesta&#231;&#245;es t&#237;picas observadas na inf&#226;ncia&#44; pois podem apresentar&#8208;se como bolhas e erup&#231;&#245;es cut&#226;neas purp&#250;ricas&#44; mais frequentemente graves e extensas&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Na cavidade oral&#44; 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&#225;rea interdigital&#44; palmas das m&#227;os&#41; e os p&#233;s &#40;parte superior dos dedos dos p&#233;s&#44; bordas laterais dos p&#233;s&#44; solas e calcanhares&#41;&#46; A erup&#231;&#227;o &#233; geralmente assintom&#225;tica e aparece ap&#243;s as les&#245;es orais&#46; Essas manifesta&#231;&#245;es obrigam ao diagn&#243;stico diferencial com herpes&#8208;z&#243;ster&#44; varicela&#44; s&#237;ndrome de Gianotti&#8208;Crosti&#44; n&#243;dulos de Orf e s&#237;filis&#46; Como observado nos pacientes descritos aqui&#44; as manifesta&#231;&#245;es cut&#226;neas at&#237;picas se estendem al&#233;m das localiza&#231;&#245;es cl&#225;ssicas da DMPB&#44; afetando o dorso das m&#227;os e a parte superior dos p&#233;s&#44; membros&#44; tronco&#44; gl&#250;teos&#44; regi&#227;o peribucal e couro cabeludo&#46; As bolhas de herpes&#8208;z&#243;ster se distinguem por sua distribui&#231;&#227;o metam&#233;rica em grupos e por serem dolorosas&#46; Na varicela&#44; o acometimento cut&#226;neo &#233; caracterizado por sua distribui&#231;&#227;o cefalocaudal&#44; com les&#245;es pruriginosas em diferentes est&#225;gios de evolu&#231;&#227;o&#46; Na s&#237;ndrome de Gianotti&#8208;Crosti&#44; o exantema apresenta in&#237;cio s&#250;bito&#44; com p&#225;pulas edematosas monom&#243;rficas&#44; papuloves&#237;culas cor da pele ou rosa&#8208;avermelhadas distribu&#237;das simetricamente na face&#44; n&#225;degas e superf&#237;cies extensoras dos membros&#44; e geralmente n&#227;o aparecem no tronco&#46; Os n&#243;dulos causados pelo v&#237;rus Orf localizam&#8208;se principalmente nas m&#227;os&#44; apresentando&#8208;se como les&#245;es maculopapulares eritematosas&#44; que evoluem para les&#245;es &#8220;em alvo&#8221; e&#44; eventualmente&#44; para n&#243;dulos azulados que podem ulcerar&#46; Nas les&#245;es de s&#237;filis secund&#225;ria&#44; embora haja envolvimento palmoplantar&#44; o tronco tamb&#233;m pode ser acometido e geralmente n&#227;o ocorrem bolhas&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de DMPB &#233; tipicamente baseado em caracter&#237;sticas cl&#237;nicas&#46; No entanto&#44; em adultos e em casos de manifesta&#231;&#245;es at&#237;picas&#44; geralmente s&#227;o necess&#225;rios estudos complementares para permitir a confirma&#231;&#227;o viral e descartar outros diagn&#243;sticos diferenciais&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As sorologias de IgM e IgG devem ser solicitadas nos dias 0 e 15 para avaliar a soroconvers&#227;o&#46; As culturas virais t&#234;m baixa sensibilidade&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A bi&#243;psia de pele n&#227;o &#233; necess&#225;ria para um diagn&#243;stico preciso&#44; mas &#233; muito &#250;til para descartar diagn&#243;sticos diferenciais&#46; Na histopatologia da DMPB&#44; s&#227;o observadas bolhas intraepid&#233;rmicas com conte&#250;do de neutr&#243;filos&#44; c&#233;lulas mononucleares e material protein&#225;ceo eosinof&#237;lico&#46; Tamb&#233;m s&#227;o observadas espongiose&#44; degenera&#231;&#227;o reticular da camada granulosa e da parte superior do estrato espinhoso&#44; necrose de grupos massa de ceratin&#243;citos&#44; exocitose de neutr&#243;filos e degenera&#231;&#227;o hidr&#243;pica da camada basal&#46; Esses achados auxiliam no diagn&#243;stico&#44; correlacionando&#8208;os com a apresenta&#231;&#227;o cl&#237;nica e os demais exames laboratoriais&#46; A amplifica&#231;&#227;o de DNA por meio de RT&#8208;PCR &#233; o m&#233;todo preferido para um diagn&#243;stico preciso de uma doen&#231;a at&#237;pica&#44; mas isso &#233; realizado apenas em laborat&#243;rios de alta tecnologia e n&#227;o est&#225; dispon&#237;vel em nossa institui&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">O tratamento &#233; sintom&#225;tico&#46; O paciente diagnosticado com DMPB &#233; potencialmente contagioso enquanto apresentar les&#245;es cut&#226;neas&#46; Portanto&#44; devem ser exclu&#237;dos das atividades de grupo e escolares at&#233; que a febre e as les&#245;es da pele e mucosas desapare&#231;am&#46; Al&#233;m disso&#44; como medida preventiva&#44; tamb&#233;m &#233; recomendado n&#227;o compartilhar objetos ou utens&#237;lios e lavar as m&#227;os meticulosamente para impedir a dissemina&#231;&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Esta entidade deve ser reconhecida tanto em crian&#231;as quanto em adultos para evitar investiga&#231;&#245;es e tratamentos desnecess&#225;rios&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Anama Di Prinzio&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#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; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dolores Pilar Bastard&#58; Revis&#227;o cr&#237;tica da literatura&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ana Clara Torre&#58; 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; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; 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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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">Filha com DMPB uma semana antes&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">&#8211;&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"><span class="elsevierStyleBold">Les&#245;es muco&#8208;cut&#226;neas</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">Enantema oral e erup&#231;&#227;o maculopapular dolorosa&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&#250;ltiplas m&#225;culas e p&#225;pulas purp&#250;ricas&#44; bolhas pruriginosas e isoladas&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">Enantema oral e &#250;lceras orais&#44; p&#225;pulas eritematosas m&#250;ltiplas e bolhas pruriginosas e dolorosas&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"><span class="elsevierStyleBold">Localiza&#231;&#227;o das Les&#245;es Muco&#8208;cut&#226;neas</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">Couro cabeludo&#44; face&#44; t&#243;rax&#44; m&#227;os e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&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">Couro cabeludo&#44; face&#44; pavilh&#245;es auriculares&#44; m&#227;os&#44; coxas e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&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">Mucosa oral&#44; dorso da l&#237;ngua e palato duro&#44; axilas&#44; cotovelos&#44; m&#227;os e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#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"><span class="elsevierStyleBold">Sintomas sist&#234;micos</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">Febre&#44; odinofagia e mal&#8208;estar geral&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">Febre&#44; mialgia e orquite bilateral&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">Odinofagia&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"><span class="elsevierStyleBold">Diagn&#243;stico presuntivo</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">S&#237;filis e DMPB&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">S&#237;filis&#44; DMPB&#44; e doen&#231;as bolhosas&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">S&#237;filis&#44; DMPB&#44; n&#243;dulos do ordenhador&#44; doen&#231;as bolhosas e erup&#231;&#227;o variceliforme de Kaposi&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"><span class="elsevierStyleBold">Dados laboratoriais</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">Sem altera&#231;&#245;es&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">Leucocitose &#40;12000&#47;mm<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#41;&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">Leucocitose&#40;13100&#47;mm<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#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"><span class="elsevierStyleBold">Sorologias</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">VDRL e HIV n&#227;o&#8208;reativas&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">HCV&#44; HBV&#44; VDRL&#44; HIV&#44; CMV&#44; EBV&#44; e parvov&#237;rus n&#227;o reativas&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">HCV&#44; HBV&#44; VDRL&#44; HIV&#44; CMV&#44; EBV&#44; HSV&#44; HZV&#44; <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">parvov&#237;rus</span> n&#227;o reativas&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  " 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><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">IgM para Coxsackiev&#237;rus B1&#8208;B6 reativa&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">IgM para Coxsackiev&#237;rus B1&#8208;B6 reativa&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">IgG para Coxsackiev&#237;rus com aumento de 4&#215; na titula&#231;&#227;o 15 dias depois&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"><span class="elsevierStyleBold">Biopsia da pele</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">&#8211;&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">Compat&#237;vel com infec&#231;&#227;o viral&#44; prov&#225;vel DMPB &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&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">Compat&#237;vel com infec&#231;&#227;o viral&#44; prov&#225;vel DMPB &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#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"><span class="elsevierStyleBold">Diagn&#243;stico</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">Sorol&#243;gico&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">Sorol&#243;gico e histopatol&#243;gico&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">Sorol&#243;gico ehistopatol&#243;gico&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"><span class="elsevierStyleBold">Tratamento</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">AINEs&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">AINEs e tratamentos &#250;midos de bolhas desnudas&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">AINEs e gargarejos com lidoca&#237;na&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"><span class="elsevierStyleBold">Evolu&#231;&#227;o cl&#237;nica</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">Resolu&#231;&#227;o em 10 dias&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">Resolu&#231;&#227;o em 15 dias&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">Resolu&#231;&#227;o em 20 dias&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"><span class="elsevierStyleBold">Complica&#231;&#245;es</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">&#8211;&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">Onic&#243;lise nas m&#227;os e p&#233;s &#40;dois meses depois&#41;&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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2929236.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Casos&#58; Registro cl&#237;nico&#44; achados cl&#237;nicos&#44; laboratoriais&#44; histopatol&#243;gicos&#44; diagn&#243;sticos&#44; tratamento e isolamento do v&#237;rus</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and course of hand&#44; foot&#44; and mouth disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Mirand"
                            1 => "H&#46; Peigue-Lafeuille"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arcped.2017.08.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr&#46;"
                        "fecha" => "2017"
                        "volumen" => "24"
                        "paginaInicial" => "1036"
                        "paginaFinal" => "1046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28893485"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coxsackievirus A6&#8211;induced hand foot&#8208;mouth disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;L&#46; Stewart"
                            1 => "E&#46;Y&#46; Chu"
                            2 => "C&#46;E&#46; Introcaso"
                            3 => "A&#46; Schaffer"
                            4 => "W&#46;D&#46; James"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2013.6777"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "149"
                        "paginaInicial" => "1419"
                        "paginaFinal" => "1421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24172861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A literature review and case report of hand&#44; foot&#44; and mouth disease in an immunocompetent adult"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Oma&#241;a-Cepeda"
                            1 => "A&#46; Mart&#237;nez-Valverde"
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Caso Clínico
Doença mão‐pé‐boca em adultos causada por Coxsackievírus B1‐B6
Anama Di Prinzio, Dolores Pilar Bastard, Ana Clara Torre
Corresponding author
, Luis Daniel Mazzuoccolo
Departamento de Dermatologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">M&#225;culas e p&#225;pulas purp&#250;ricas eritematosas e bolhas isoladas&#44; localizadas nos p&#233;s&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A doen&#231;a m&#227;o&#8208;p&#233;&#8208;boca &#40;DMPB&#41; &#233; doen&#231;a por <span class="elsevierStyleItalic">Rickettsia</span> frequentemente causada por v&#237;rus da fam&#237;lia Picornaviridae&#44; g&#234;nero enterov&#237;rus humano&#46; Coxsackiev&#237;rus &#40;CA&#41; A16 e Enterov&#237;rus &#40;EV&#41; 71 s&#227;o os mais frequentemente isolados&#46; Em 97&#37; dos casos&#44; a DMPB afeta crian&#231;as menores de 10 anos&#46; Os tipos sorol&#243;gicos A 5&#8208;7&#44; A 10&#44; B 1&#8208;3 e B5&#8208;B6 s&#227;o algumas vezes isolados&#46; De acordo com a literatura&#44; CA A6 &#233; o sorotipo mais frequente em adultos&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A DMPB tem taxa de infec&#231;&#227;o alta&#46; A transmiss&#227;o de pessoa para pessoa ocorre atrav&#233;s do contato direto com secre&#231;&#227;o nasal&#44; saliva&#44; fezes ou objetos contaminados&#46; A doen&#231;a geralmente aparece na forma de surtos epid&#234;micos na primavera&#44; ver&#227;o ou in&#237;cio do outono&#46; O per&#237;odo de incuba&#231;&#227;o &#233; de tr&#234;s a seis dias&#46; Depois de entrar em contato&#44; o v&#237;rus se implanta na mucosa oral ou do &#237;leo&#44; da&#237; espalhando&#8208;se para o sangue&#59; isto &#233; conhecido como viremia prim&#225;ria&#46; Ap&#243;s 24 horas no sangue&#44; o v&#237;rus come&#231;a a se espalhar para o tecido linf&#225;tico e diferentes &#243;rg&#227;os&#46; A elimina&#231;&#227;o respirat&#243;ria do v&#237;rus pode persistir por tr&#234;s semanas&#44; e a elimina&#231;&#227;o digestiva&#44; por oito semanas&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Na maioria dos casos&#44; principalmente em crian&#231;as&#44; a DMPB apresenta&#8208;se como enantema&#44; p&#225;pulas e&#47;ou bolhas nas m&#227;os e nos p&#233;s&#44; que podem desaparecer em uma a duas semanas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Relato do caso</span><p id="par0020" class="elsevierStylePara elsevierViewall">Tr&#234;s casos de DMPB s&#227;o relatados em pacientes adultos&#46; S&#227;o descritos sua etiologia&#44; manifesta&#231;&#245;es cl&#237;nicas&#44; diagn&#243;stico diferencial&#44; abordagem diagn&#243;stica&#44; tratamento realizado e evolu&#231;&#227;o cl&#237;nica &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#59; <a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1&#44; 2&#44; 3&#44; 4 e 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discuss&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">A DMPB &#233; doen&#231;a viral incomum em adultos como resultado de imunidade cruzada com outros enterov&#237;rus e mem&#243;ria imunol&#243;gica&#46; Entretanto&#44; um aumento de casos com apresenta&#231;&#227;o cl&#237;nica at&#237;pica e um diagn&#243;stico dif&#237;cil foram observados nessa faixa et&#225;ria nos &#250;ltimos anos&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diferente das publica&#231;&#245;es internacionais&#44; os casos descritos no presente relato foram causados pelo Coxsackiev&#237;rus B1&#8208;B6&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As manifesta&#231;&#245;es cl&#237;nicas da DMPB em adultos s&#227;o diferentes das manifesta&#231;&#245;es t&#237;picas observadas na inf&#226;ncia&#44; pois podem apresentar&#8208;se como bolhas e erup&#231;&#245;es cut&#226;neas purp&#250;ricas&#44; mais frequentemente graves e extensas&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Na cavidade oral&#44; a DMPB pode se apresentar como les&#245;es que variam de enantema com bolhas a &#250;lceras que podem acometer qualquer &#225;rea da mucosa oral&#46; Portanto&#44; deve ser diferenciada de outras doen&#231;as que acometem a cavidade oral&#44; como gengivoestomatite herp&#233;tica aguda &#40;GEHA&#41;&#44; estomatite aftosa recorrente &#40;EAR&#41;&#44; herpes simples e herpangina&#46; Na GEHA e EAR&#44; as les&#245;es tendem a ser &#250;lceras hemorr&#225;gicas que afetam as gengivas&#44; a l&#237;ngua&#44; o palato duro e&#44; em alguns casos&#44; a faringe&#46; A herpangina apresenta&#8208;se como um enantema papulovesicular doloroso&#44; que pode evoluir para pequenas &#250;lceras amarelo&#8208;acinzentadas com bordas eritematosas&#46; Na maioria dos casos&#44; afeta o palato mole&#44; as tonsilas e a faringe posterior e geralmente &#233; precedida por febre alta&#46; Entretanto&#44; nenhuma dessas doen&#231;as afeta simultaneamente as m&#227;os e os p&#233;s como a DMPB&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;5&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A erup&#231;&#227;o papulovesicular usual na DMPB afeta as m&#227;os &#40;dorso dos dedos&#44; &#225;rea interdigital&#44; palmas das m&#227;os&#41; e os p&#233;s &#40;parte superior dos dedos dos p&#233;s&#44; bordas laterais dos p&#233;s&#44; solas e calcanhares&#41;&#46; A erup&#231;&#227;o &#233; geralmente assintom&#225;tica e aparece ap&#243;s as les&#245;es orais&#46; Essas manifesta&#231;&#245;es obrigam ao diagn&#243;stico diferencial com herpes&#8208;z&#243;ster&#44; varicela&#44; s&#237;ndrome de Gianotti&#8208;Crosti&#44; n&#243;dulos de Orf e s&#237;filis&#46; Como observado nos pacientes descritos aqui&#44; as manifesta&#231;&#245;es cut&#226;neas at&#237;picas se estendem al&#233;m das localiza&#231;&#245;es cl&#225;ssicas da DMPB&#44; afetando o dorso das m&#227;os e a parte superior dos p&#233;s&#44; membros&#44; tronco&#44; gl&#250;teos&#44; regi&#227;o peribucal e couro cabeludo&#46; As bolhas de herpes&#8208;z&#243;ster se distinguem por sua distribui&#231;&#227;o metam&#233;rica em grupos e por serem dolorosas&#46; Na varicela&#44; o acometimento cut&#226;neo &#233; caracterizado por sua distribui&#231;&#227;o cefalocaudal&#44; com les&#245;es pruriginosas em diferentes est&#225;gios de evolu&#231;&#227;o&#46; Na s&#237;ndrome de Gianotti&#8208;Crosti&#44; o exantema apresenta in&#237;cio s&#250;bito&#44; com p&#225;pulas edematosas monom&#243;rficas&#44; papuloves&#237;culas cor da pele ou rosa&#8208;avermelhadas distribu&#237;das simetricamente na face&#44; n&#225;degas e superf&#237;cies extensoras dos membros&#44; e geralmente n&#227;o aparecem no tronco&#46; Os n&#243;dulos causados pelo v&#237;rus Orf localizam&#8208;se principalmente nas m&#227;os&#44; apresentando&#8208;se como les&#245;es maculopapulares eritematosas&#44; que evoluem para les&#245;es &#8220;em alvo&#8221; e&#44; eventualmente&#44; para n&#243;dulos azulados que podem ulcerar&#46; Nas les&#245;es de s&#237;filis secund&#225;ria&#44; embora haja envolvimento palmoplantar&#44; o tronco tamb&#233;m pode ser acometido e geralmente n&#227;o ocorrem bolhas&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de DMPB &#233; tipicamente baseado em caracter&#237;sticas cl&#237;nicas&#46; No entanto&#44; em adultos e em casos de manifesta&#231;&#245;es at&#237;picas&#44; geralmente s&#227;o necess&#225;rios estudos complementares para permitir a confirma&#231;&#227;o viral e descartar outros diagn&#243;sticos diferenciais&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As sorologias de IgM e IgG devem ser solicitadas nos dias 0 e 15 para avaliar a soroconvers&#227;o&#46; As culturas virais t&#234;m baixa sensibilidade&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A bi&#243;psia de pele n&#227;o &#233; necess&#225;ria para um diagn&#243;stico preciso&#44; mas &#233; muito &#250;til para descartar diagn&#243;sticos diferenciais&#46; Na histopatologia da DMPB&#44; s&#227;o observadas bolhas intraepid&#233;rmicas com conte&#250;do de neutr&#243;filos&#44; c&#233;lulas mononucleares e material protein&#225;ceo eosinof&#237;lico&#46; Tamb&#233;m s&#227;o observadas espongiose&#44; degenera&#231;&#227;o reticular da camada granulosa e da parte superior do estrato espinhoso&#44; necrose de grupos massa de ceratin&#243;citos&#44; exocitose de neutr&#243;filos e degenera&#231;&#227;o hidr&#243;pica da camada basal&#46; Esses achados auxiliam no diagn&#243;stico&#44; correlacionando&#8208;os com a apresenta&#231;&#227;o cl&#237;nica e os demais exames laboratoriais&#46; A amplifica&#231;&#227;o de DNA por meio de RT&#8208;PCR &#233; o m&#233;todo preferido para um diagn&#243;stico preciso de uma doen&#231;a at&#237;pica&#44; mas isso &#233; realizado apenas em laborat&#243;rios de alta tecnologia e n&#227;o est&#225; dispon&#237;vel em nossa institui&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">O tratamento &#233; sintom&#225;tico&#46; O paciente diagnosticado com DMPB &#233; potencialmente contagioso enquanto apresentar les&#245;es cut&#226;neas&#46; Portanto&#44; devem ser exclu&#237;dos das atividades de grupo e escolares at&#233; que a febre e as les&#245;es da pele e mucosas desapare&#231;am&#46; Al&#233;m disso&#44; como medida preventiva&#44; tamb&#233;m &#233; recomendado n&#227;o compartilhar objetos ou utens&#237;lios e lavar as m&#227;os meticulosamente para impedir a dissemina&#231;&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Esta entidade deve ser reconhecida tanto em crian&#231;as quanto em adultos para evitar investiga&#231;&#245;es e tratamentos desnecess&#225;rios&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Suporte financeiro</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Contribui&#231;&#227;o dos autores</span><p id="par0080" class="elsevierStylePara elsevierViewall">Anama Di Prinzio&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#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; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dolores Pilar Bastard&#58; Revis&#227;o cr&#237;tica da literatura&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ana Clara Torre&#58; 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; 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&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Luis Daniel Mazzuoccolo&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">DMPB&#44; doen&#231;a m&#227;o&#8208;p&#233;&#8208;boca&#59; HCV&#44; v&#237;rus da hepatite C&#59; HBV&#44; v&#237;rus da hepatite B&#59; VDRL&#44; Venereal Disease Research Laboratory&#59; HIV&#44; v&#237;rus da imunodefici&#234;ncia humana&#59; CMV&#44; citomegalov&#237;rus&#59; EBV&#44; v&#237;rus de Epstein&#8208;Barr&#59; HSV&#44; v&#237;rus do herpes&#8208;simplex&#59; HZV&#44; v&#237;rus do herpes&#8208;z&#243;ster&#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="" 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">Paciente 1&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">Paciente 2&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">Paciente 3&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"><span class="elsevierStyleBold">Sexo</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">Masculino&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">Masculino&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">Masculino&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"><span class="elsevierStyleBold">Idade &#40;anos&#41;</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">33&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">39&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">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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"><span class="elsevierStyleBold">Antecedentes epidemiol&#243;gicos</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">&#8211;&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">Filha com DMPB uma semana antes&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">&#8211;&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"><span class="elsevierStyleBold">Les&#245;es muco&#8208;cut&#226;neas</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">Enantema oral e erup&#231;&#227;o maculopapular dolorosa&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&#250;ltiplas m&#225;culas e p&#225;pulas purp&#250;ricas&#44; bolhas pruriginosas e isoladas&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">Enantema oral e &#250;lceras orais&#44; p&#225;pulas eritematosas m&#250;ltiplas e bolhas pruriginosas e dolorosas&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"><span class="elsevierStyleBold">Localiza&#231;&#227;o das Les&#245;es Muco&#8208;cut&#226;neas</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">Couro cabeludo&#44; face&#44; t&#243;rax&#44; m&#227;os e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&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">Couro cabeludo&#44; face&#44; pavilh&#245;es auriculares&#44; m&#227;os&#44; coxas e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&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">Mucosa oral&#44; dorso da l&#237;ngua e palato duro&#44; axilas&#44; cotovelos&#44; m&#227;os e p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#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"><span class="elsevierStyleBold">Sintomas sist&#234;micos</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">Febre&#44; odinofagia e mal&#8208;estar geral&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">Febre&#44; mialgia e orquite bilateral&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">Odinofagia&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"><span class="elsevierStyleBold">Diagn&#243;stico presuntivo</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">S&#237;filis e DMPB&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">S&#237;filis&#44; DMPB&#44; e doen&#231;as bolhosas&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">S&#237;filis&#44; DMPB&#44; n&#243;dulos do ordenhador&#44; doen&#231;as bolhosas e erup&#231;&#227;o variceliforme de Kaposi&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"><span class="elsevierStyleBold">Dados laboratoriais</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">Sem altera&#231;&#245;es&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">Leucocitose &#40;12000&#47;mm<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#41;&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">Leucocitose&#40;13100&#47;mm<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#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"><span class="elsevierStyleBold">Sorologias</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">VDRL e HIV n&#227;o&#8208;reativas&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">HCV&#44; HBV&#44; VDRL&#44; HIV&#44; CMV&#44; EBV&#44; e parvov&#237;rus n&#227;o reativas&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">HCV&#44; HBV&#44; VDRL&#44; HIV&#44; CMV&#44; EBV&#44; HSV&#44; HZV&#44; <span class="elsevierStyleItalic">Mycoplasma</span> e <span class="elsevierStyleItalic">parvov&#237;rus</span> n&#227;o reativas&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  " 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><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">IgM para Coxsackiev&#237;rus B1&#8208;B6 reativa&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">IgM para Coxsackiev&#237;rus B1&#8208;B6 reativa&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">IgG para Coxsackiev&#237;rus com aumento de 4&#215; na titula&#231;&#227;o 15 dias depois&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"><span class="elsevierStyleBold">Biopsia da pele</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">&#8211;&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">Compat&#237;vel com infec&#231;&#227;o viral&#44; prov&#225;vel DMPB &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&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">Compat&#237;vel com infec&#231;&#227;o viral&#44; prov&#225;vel DMPB &#40;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#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"><span class="elsevierStyleBold">Diagn&#243;stico</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">Sorol&#243;gico&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">Sorol&#243;gico e histopatol&#243;gico&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">Sorol&#243;gico ehistopatol&#243;gico&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"><span class="elsevierStyleBold">Tratamento</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">AINEs&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">AINEs e tratamentos &#250;midos de bolhas desnudas&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">AINEs e gargarejos com lidoca&#237;na&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"><span class="elsevierStyleBold">Evolu&#231;&#227;o cl&#237;nica</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">Resolu&#231;&#227;o em 10 dias&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">Resolu&#231;&#227;o em 15 dias&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">Resolu&#231;&#227;o em 20 dias&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleBold">Complica&#231;&#245;es</span>&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">&#8211;&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">Onic&#243;lise nas m&#227;os e p&#233;s &#40;dois meses depois&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "bib0045"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical characteristics and course of hand&#44; foot&#44; and mouth disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Mirand"
                            1 => "H&#46; Peigue-Lafeuille"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arcped.2017.08.001"
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                        "tituloSerie" => "Arch Pediatr&#46;"
                        "fecha" => "2017"
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                        "paginaInicial" => "1036"
                        "paginaFinal" => "1046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28893485"
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                      ]
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                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coxsackievirus A6&#8211;induced hand foot&#8208;mouth disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "C&#46;E&#46; Introcaso"
                            3 => "A&#46; Schaffer"
                            4 => "W&#46;D&#46; James"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2013.6777"
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                        "tituloSerie" => "JAMA Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "149"
                        "paginaInicial" => "1419"
                        "paginaFinal" => "1421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24172861"
                            "web" => "Medline"
                          ]
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                ]
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              "etiqueta" => "3"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A literature review and case report of hand&#44; foot&#44; and mouth disease in an immunocompetent adult"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            2 => "M&#46;M&#46; Sabater-Recolons"
                            3 => "E&#46; Jan&#233;-Salas"
                            4 => "A&#46; Mar&#237;-Roig"
                            5 => "J&#46; L&#243;pez-L&#243;pez"
                          ]
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1186/s13104-016-1973-y"
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                        "tituloSerie" => "BMC Res Notes&#46;"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26975350"
                            "web" => "Medline"
                          ]
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                            1 => "S&#46;H&#46; Oh"
                            2 => "J&#46;H&#46; Lee"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.5021/ad.2010.22.2.216"
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                        "tituloSerie" => "Ann Dermatol&#46;"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20548919"
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                            2 => "B&#46; Salvaneschi"
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                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dermatol Argent&#46;"
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                    0 => array:2 [
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                        0 => array:2 [
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                            4 => "C&#46; Mainetti"
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                        "paginaFinal" => "209"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu"
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                            4 => "Q&#46;Y&#46; Mao"
                            5 => "Y&#46;P&#46; Wang"
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                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/21645515.2016.1236879"
                      "Revista" => array:6 [
                        "tituloSerie" => "China&#44; 2013&#8208;2014&#46; Hum Vaccin Immunother&#46;"
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Article information
ISSN: 26662752
Original language: Portuguese
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