array:24 [
  "pii" => "S0365059621000076"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2020.06.010"
  "estado" => "S300"
  "fechaPublicacion" => "2021-03-01"
  "aid" => "308"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2021"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by/4.0/"
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S2666275221000096"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2020.06.012"
      "estado" => "S300"
      "fechaPublicacion" => "2021-03-01"
      "aid" => "308"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "crp"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso Cl&#237;nico</span>"
        "titulo" => "Tumores cut&#226;neos de m&#250;sculo liso associados ao v&#237;rus de Epstein&#8208;Barr em paciente adulto com HIV"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "184"
            "paginaFinal" => "187"
          ]
        ]
        "contieneResumen" => array:1 [
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0025"
            "etiqueta" => "Figura 5"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr5.jpeg"
                "Alto" => 1875
                "Ancho" => 2508
                "Tamanyo" => 822707
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo de hibridiza&#231;&#227;o <span class="elsevierStyleItalic">in situ</span> positivo para v&#237;rus Epstein&#8208;Barr&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Estefania Galeano&#8208;Piedrahita, Ana Maria Maya Rico, Ana Cristina Ruiz Su&#225;rez, Andrea Laverde Walter"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Estefania"
                "apellidos" => "Galeano&#8208;Piedrahita"
              ]
              1 => array:2 [
                "nombre" => "Ana Maria Maya"
                "apellidos" => "Rico"
              ]
              2 => array:2 [
                "nombre" => "Ana Cristina Ruiz"
                "apellidos" => "Su&#225;rez"
              ]
              3 => array:2 [
                "nombre" => "Andrea Laverde"
                "apellidos" => "Walter"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059621000076"
          "doi" => "10.1016/j.abd.2020.06.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000076?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221000096?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009600000002/v2_202104230742/S2666275221000096/v2_202104230742/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059621000271"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2020.06.014"
    "estado" => "S300"
    "fechaPublicacion" => "2021-03-01"
    "aid" => "326"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Pyoderma gangrenosum associated to the use of cocaine&#47;levamisole&#46; Series of three cases and literature review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "188"
          "paginaFinal" => "195"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0020"
          "etiqueta" => "Figure 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 1128
              "Ancho" => 1740
              "Tamanyo" => 129572
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0020"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41;&#46; Superficial ulcers&#44; round in shape&#44; well-defined&#44; raised and slightly violet borders on both legs&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Manuel Mart&#237;nez-G&#243;mez, Joan Andr&#233;s Ram&#237;rez-Ospina, Juan David Ruiz-Restrepo, Margarita Mar&#237;a Vel&#225;squez-Lopera"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Mart&#237;nez-G&#243;mez"
            ]
            1 => array:2 [
              "nombre" => "Joan Andr&#233;s"
              "apellidos" => "Ram&#237;rez-Ospina"
            ]
            2 => array:2 [
              "nombre" => "Juan David"
              "apellidos" => "Ruiz-Restrepo"
            ]
            3 => array:2 [
              "nombre" => "Margarita Mar&#237;a"
              "apellidos" => "Vel&#225;squez-Lopera"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221000254"
        "doi" => "10.1016/j.abdp.2020.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221000254?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000271?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009600000002/v2_202104300920/S0365059621000271/v2_202104300920/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0365059621000155"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2020.07.007"
    "estado" => "S300"
    "fechaPublicacion" => "2021-03-01"
    "aid" => "314"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Main etiological agents identified in 170 men with urethritis attended at the Funda&#231;&#227;o Alfredo da Matta&#44; Manaus&#44; Amazonas&#44; Brazil"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "176"
          "paginaFinal" => "183"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lucilene Sales de Souza, Jos&#233; Carlos Sardinha, Sin&#233;sio Talhari, Marcel Heibel, M&#244;nica Nunes dos Santos, Carolina Talhari"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Lucilene Sales"
              "apellidos" => "de Souza"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233; Carlos"
              "apellidos" => "Sardinha"
            ]
            2 => array:2 [
              "nombre" => "Sin&#233;sio"
              "apellidos" => "Talhari"
            ]
            3 => array:2 [
              "nombre" => "Marcel"
              "apellidos" => "Heibel"
            ]
            4 => array:2 [
              "nombre" => "M&#244;nica Nunes dos"
              "apellidos" => "Santos"
            ]
            5 => array:2 [
              "nombre" => "Carolina"
              "apellidos" => "Talhari"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221000138"
        "doi" => "10.1016/j.abdp.2020.07.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221000138?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000155?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009600000002/v2_202104300920/S0365059621000155/v2_202104300920/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
    "titulo" => "Cutaneous smooth muscle tumors associated with Epstein-Barr virus in an adult patient with HIV"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "184"
        "paginaFinal" => "187"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Estefania Galeano-Piedrahita, Ana Maria Maya Rico, Ana Cristina Ruiz Su&#225;rez, Andrea Laverde Walter"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Estefania"
            "apellidos" => "Galeano-Piedrahita"
            "email" => array:1 [
              0 => "estefaniadermatologia@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Ana Maria Maya"
            "apellidos" => "Rico"
          ]
          2 => array:2 [
            "nombre" => "Ana Cristina Ruiz"
            "apellidos" => "Su&#225;rez"
          ]
          3 => array:2 [
            "nombre" => "Andrea Laverde"
            "apellidos" => "Walter"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Dermatology Service&#44; CES University&#44; Medell&#237;n&#44; Antioquia&#44; Colombia"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1141
            "Ancho" => 1500
            "Tamanyo" => 358261
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous nodule&#46; &#40;A and B&#41;&#44; well circumscribed nodular formation formed by spindle cell bundles with minimal atypia and few mitotic figures &#40;Hematoxylin &#38; eosin &#215;100 and &#215;400&#44; respectively&#41;&#46; &#40;C and D&#41;&#44; SMA and H-caldesmon positive immunohistochemistry&#44; respectively&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epstein-Barr virus &#40;EBV&#41;-associated smooth muscle tumors are a rare neoplasm associated with immunosuppression&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Their relationship with EBV has been studied extensively for more than 20 years and they have been documented in both pediatric and adult patients&#44; with a slight female predominance&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Skin manifestations are uncommon and have been related to patients with human immunodeficiency virus &#40;HIV&#41; infection&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The following report describes a confirmed case of a patient with HIV and presence of multifocal cutaneous and epidural smooth muscle neoplasms&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">40-year-old male patient with a diagnosis of HIV infection since 2006 in low-adherence antiretroviral therapy&#44; who presents a two-year history of the appearance of four painful&#44; slow-growing lesions in the limbs and abdomen&#44; associated with low back pain&#46; The physical examination showed well defined subcutaneous nodules&#44; mobile&#44; of a rubbery consistency and very painful&#44; located in the left forearm &#40;1&#8239;&#215;&#8239;1&#46;5&#8239;cm&#41;&#44; abdomen &#40;0&#46;5&#8239;&#215;&#8239;0&#46;5&#8239;cm&#41;&#44; left thigh &#40;1&#8239;&#215;&#8239;0&#46;5&#8239;cm&#41;&#44; and one of larger size and linear shape on the dorsum of the right hand &#40;2&#8239;&#215;&#8239;1&#8239;cm&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Within the relevant laboratory&#44; 2&#44;200 leukocytes&#44; 920 lymphocytes&#44; with CD4 of 6 cells&#47;mcL and a viral load of 36&#44;600 copies are reported&#46; In the magnetic resonance imaging &#40;MRI&#41; of the contrasted spine&#44; an extensive epidural infiltration with foraminal involvement of T4-T5&#44; T7&#44; T11&#44; and T12 with compression and displacement of the spinal cord is evident &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A biopsy of one of the skin lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and of the epidural mass &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; were taken with findings similar to histology&#44; finding a positive fusocellular neoplasm for H-caldesmon and smooth muscle actin &#40;SMA&#41; a diagnosis of smooth muscle tumor&#46; Subsequently&#44; an <span class="elsevierStyleItalic">in situ</span> hybridization study was performed for the detection of the Epstein-Barr virus encoding region &#40;EBER&#41;&#44; which was positive &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><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">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">The relationship between smooth muscle tumors and immunosuppression was first documented in 1970 by Pritzker et al&#46;&#44; and it was only in1995 that their link to EBV was identified&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a> This association has been established in post-transplanted patients&#44; with primary immunodeficiencies and HIV&#44; mainly in those with CD4 less than 200 cells&#47;mcL&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The majority present multifocal compromise&#44; as in the case of the current patient&#44; with a predominance in the spinal cord&#44; epidural space&#44; gastrointestinal tract and liver&#44; upper respiratory tract&#44; and skin&#44; the latter organ having few cases reported in the literature and none in Colombia&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although its pathogenesis is poorly understood&#44; it has been suggested that EBV infects smooth muscle cells directly by adhering to CD21 facilitating the replication of these cells&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other theories are based on the overexpression of the proto-oncogene MYC and the activation of the AkT&#47;m TOR pathway triggered by the LMP2A protein&#44; which promotes cell proliferation and tumor formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis is made based on physical examination&#44; radiology&#44; and findings in the histological and immunohistochemical study&#59; it is confirmed with <span class="elsevierStyleItalic">in situ</span> hybridization study for the detection of the Epstein-Barr virus&#44; as was done in the representative case&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The presence of these lesions in the central nervous system has been associated with a worse prognosis&#59; regarding treatment&#44; there are some case reports of reversal of the neoplasms with the improvement of immunosuppression&#44; surgical resection for isolated lesions have been published&#44; and the use of radiotherapy and chemotherapy such as sirolimus&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; most reports are in patients without HIV infection and the results have not been completely satisfactory&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estefania Galeano-Piedrahita&#58; Approval of the final version of the manuscript&#59; study conception and planning&#59; preparation and writing of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ana Maria Maya Rico&#58; Approval of the final version of the manuscript&#59; study conception and planning&#59; preparation and writing of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ana Cristina Ruiz Su&#225;rez&#58; Approval of the final version of the manuscript&#59; study conception and planning&#59; preparation and writing of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Andrea Laverde Walter&#58; Approval of the final version of the manuscript&#59; study conception and planning&#59; preparation and writing of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1505254"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1366010"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        5 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Financial support"
        ]
        6 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Authors&#8217; contributions"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-03-02"
    "fechaAceptado" => "2020-06-21"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1366010"
          "palabras" => array:4 [
            0 => "Epstein-Barr virus infections"
            1 => "HIV"
            2 => "Skin manifestations"
            3 => "Smooth muscle tumor"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age&#46; Usually&#44; it presents as multifocal tumors mainly in the spinal cord&#44; epidural region&#44; gastrointestinal tract and liver&#44; upper respiratory tract and skin&#44; the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome&#46; The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region&#44; confirmed by histopathology&#44; immunohistochemistry and in situ hybridization studies&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Galeano-Piedrahita E&#44; Rico AMM&#44; Su&#225;rez ACR&#44; Walter AL&#46; Cutaneous smooth muscle tumors associated with Epstein Barr virus in an adult patient with HIV&#46; An Bras Dermatol&#46; 2021&#59;96&#58;184&#8211;7&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the CES University&#44; Medell&#237;n&#44; Antioquia&#44; Colombia&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 636
            "Ancho" => 900
            "Tamanyo" => 53772
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Linear subcutaneous nodule on the dorsum of the right hand&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 987
            "Ancho" => 750
            "Tamanyo" => 57390
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nuclear magnetic resonance of the spine with epidural infiltration and foraminal involvement of T11 and T12&#44; with compression and displacement of the spinal cord&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1141
            "Ancho" => 1500
            "Tamanyo" => 358261
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous nodule&#46; &#40;A and B&#41;&#44; well circumscribed nodular formation formed by spindle cell bundles with minimal atypia and few mitotic figures &#40;Hematoxylin &#38; eosin &#215;100 and &#215;400&#44; respectively&#41;&#46; &#40;C and D&#41;&#44; SMA and H-caldesmon positive immunohistochemistry&#44; respectively&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1147
            "Ancho" => 1500
            "Tamanyo" => 334383
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Epidural lesion&#46; &#40;A and B&#41;&#44; confused lesion by spindle cell bundles with low atypia &#40;Hematoxylin &#38; eosin &#215;100 and &#215;400&#44; respectively&#41;&#46; &#40;C and D&#41;&#44; SMA and H-caldesmon positive immunohistochemistry&#44; respectively&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 672
            "Ancho" => 900
            "Tamanyo" => 186534
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">In situ</span> hybridization study for detection of Epstein-Barr virus&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epstein-Barr virus-associated smooth muscle tumor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Dekate"
                            1 => "R&#46; Chetty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5858/arpa.2015-0120-RS"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pathol Lab Med&#46;"
                        "fecha" => "2016"
                        "volumen" => "140"
                        "paginaInicial" => "718"
                        "paginaFinal" => "722"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27362573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; McClain"
                            1 => "C&#46;T&#46; Leach"
                            2 => "H&#46;B&#46; Jenson"
                            3 => "V&#46;V&#46; Joshi"
                            4 => "B&#46;H&#46; Pollock"
                            5 => "R&#46;T&#46; Parmley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199501053320103"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1995"
                        "volumen" => "332"
                        "paginaInicial" => "12"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7990860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epstein-Barr virus-associated smooth muscle tumors in AIDS patients&#58; a largest case &#40;series&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Issarachaikul"
                            1 => "S&#46; Shuangshoti"
                            2 => "C&#46; Suankratay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.53.2674"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med&#46;"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "2391"
                        "paginaFinal" => "2396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25318810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AIDS-related EBV-associated smooth muscle tumors&#58; a review of 64 published cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Purgina"
                            1 => "U&#46;N&#46;M&#46; Rao"
                            2 => "M&#46; Miettinen"
                            3 => "L&#46; Pantanowitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4061/2011/561548"
                      "Revista" => array:5 [
                        "tituloSerie" => "Patholog Res Int&#46;"
                        "fecha" => "2011"
                        "volumen" => "2011"
                        "paginaInicial" => "561548"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21437186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant tumours following immunosuppressive therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;P&#46; Pritzker"
                            1 => "S&#46;N&#46; Huang"
                            2 => "K&#46;G&#46; Marshall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Med Assoc J"
                        "fecha" => "1970"
                        "volumen" => "103"
                        "paginaInicial" => "1362"
                        "paginaFinal" => "1365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4923839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epstein-Barr virus infection-associated smooth-muscle tumors in patients with AIDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Suankratay"
                            1 => "S&#46; Shuangshoti"
                            2 => "A&#46; Mutirangura"
                            3 => "V&#46; Prasanthai"
                            4 => "S&#46; Lerdlum"
                            5 => "S&#46; Shuangshoti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/429830"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis&#46;"
                        "fecha" => "2005"
                        "volumen" => "40"
                        "paginaInicial" => "1521"
                        "paginaFinal" => "1528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15844077"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of natural Epstein-Barr virus infection and replication in smooth muscle cells from a leiomyosarcoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;B&#46; Jenson"
                            1 => "E&#46;A&#46; Montalvo"
                            2 => "K&#46;L&#46; McClain"
                            3 => "Y&#46; Ench"
                            4 => "P&#46; Heard"
                            5 => "B&#46;A&#46; Christy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Virol&#46;"
                        "fecha" => "1999"
                        "volumen" => "57"
                        "paginaInicial" => "36"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9890420"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modulation of the cell growth regulator mTOR by Epstein-Barr virus-encoded LMP2A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Moody"
                            1 => "R&#46;S&#46; Scott"
                            2 => "N&#46; Amirghahari"
                            3 => "C&#46;-A&#46; Nathan"
                            4 => "L&#46;S&#46; Young"
                            5 => "C&#46;W&#46; Dawson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/JVI.79.9.5499-5506.2005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Virol&#46;"
                        "fecha" => "2005"
                        "volumen" => "79"
                        "paginaInicial" => "5499"
                        "paginaFinal" => "5506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15827164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epstein Barr virus-associated tumours&#58; an update for the attention of the working pathologist"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;-J&#46; Delecluse"
                            1 => "R&#46; Feederle"
                            2 => "B&#46; O&#8217;Sullivan"
                            3 => "P&#46; Taniere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/jcp.2006.044586"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Pathol&#46;"
                        "fecha" => "2006"
                        "volumen" => "60"
                        "paginaInicial" => "1358"
                        "paginaFinal" => "1364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17873116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of sirolimus for Epstein-Barr virus-positive smooth-muscle tumour"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;C&#46; Toh"
                            1 => "M&#46; Teo"
                            2 => "K&#46;W&#46; Ong"
                            3 => "V&#46; Lee"
                            4 => "E&#46; Chan"
                            5 => "A&#46;S&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1470-2045(06)70943-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol&#46;"
                        "fecha" => "2006"
                        "volumen" => "7"
                        "paginaInicial" => "955"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17081922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009600000002/v2_202104300920/S0365059621000076/v2_202104300920/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80638"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009600000002/v2_202104300920/S0365059621000076/v2_202104300920/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621000076?idApp=UINPBA00008Z"
]
Compartilhar
Informação da revista
Vol. 96. Núm. 2.
Páginas 184-187 (1 março 2021)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Visitas
6775
Vol. 96. Núm. 2.
Páginas 184-187 (1 março 2021)
Case Report
Open Access
Cutaneous smooth muscle tumors associated with Epstein-Barr virus in an adult patient with HIV
Visitas
6775
Estefania Galeano-Piedrahita
Autor para correspondência
estefaniadermatologia@gmail.com

Corresponding author.
, Ana Maria Maya Rico, Ana Cristina Ruiz Suárez, Andrea Laverde Walter
Dermatology Service, CES University, Medellín, Antioquia, Colombia
Este item recebeu

Under a Creative Commons license
Informação do artigo
Resume
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Figuras (5)
Mostrar maisMostrar menos
Abstract

Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age. Usually, it presents as multifocal tumors mainly in the spinal cord, epidural region, gastrointestinal tract and liver, upper respiratory tract and skin, the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome. The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region, confirmed by histopathology, immunohistochemistry and in situ hybridization studies.

Keywords:
Epstein-Barr virus infections
HIV
Skin manifestations
Smooth muscle tumor
Texto Completo
Introduction

Epstein-Barr virus (EBV)-associated smooth muscle tumors are a rare neoplasm associated with immunosuppression.1 Their relationship with EBV has been studied extensively for more than 20 years and they have been documented in both pediatric and adult patients, with a slight female predominance.2,3 Skin manifestations are uncommon and have been related to patients with human immunodeficiency virus (HIV) infection.4 The following report describes a confirmed case of a patient with HIV and presence of multifocal cutaneous and epidural smooth muscle neoplasms.

Case report

40-year-old male patient with a diagnosis of HIV infection since 2006 in low-adherence antiretroviral therapy, who presents a two-year history of the appearance of four painful, slow-growing lesions in the limbs and abdomen, associated with low back pain. The physical examination showed well defined subcutaneous nodules, mobile, of a rubbery consistency and very painful, located in the left forearm (1 × 1.5 cm), abdomen (0.5 × 0.5 cm), left thigh (1 × 0.5 cm), and one of larger size and linear shape on the dorsum of the right hand (2 × 1 cm) (Fig. 1). Within the relevant laboratory, 2,200 leukocytes, 920 lymphocytes, with CD4 of 6 cells/mcL and a viral load of 36,600 copies are reported. In the magnetic resonance imaging (MRI) of the contrasted spine, an extensive epidural infiltration with foraminal involvement of T4-T5, T7, T11, and T12 with compression and displacement of the spinal cord is evident (Fig. 2). A biopsy of one of the skin lesions (Fig. 3) and of the epidural mass (Fig. 4) were taken with findings similar to histology, finding a positive fusocellular neoplasm for H-caldesmon and smooth muscle actin (SMA) a diagnosis of smooth muscle tumor. Subsequently, an in situ hybridization study was performed for the detection of the Epstein-Barr virus encoding region (EBER), which was positive (Fig. 5).

Figure 1.

Linear subcutaneous nodule on the dorsum of the right hand.

(0.05MB).
Figure 2.

Nuclear magnetic resonance of the spine with epidural infiltration and foraminal involvement of T11 and T12, with compression and displacement of the spinal cord.

(0.05MB).
Figure 3.

Subcutaneous nodule. (A and B), well circumscribed nodular formation formed by spindle cell bundles with minimal atypia and few mitotic figures (Hematoxylin & eosin ×100 and ×400, respectively). (C and D), SMA and H-caldesmon positive immunohistochemistry, respectively.

(0.34MB).
Figure 4.

Epidural lesion. (A and B), confused lesion by spindle cell bundles with low atypia (Hematoxylin & eosin ×100 and ×400, respectively). (C and D), SMA and H-caldesmon positive immunohistochemistry, respectively.

(0.32MB).
Figure 5.

In situ hybridization study for detection of Epstein-Barr virus.

(0.18MB).
Discussion

The relationship between smooth muscle tumors and immunosuppression was first documented in 1970 by Pritzker et al., and it was only in1995 that their link to EBV was identified.2,5 This association has been established in post-transplanted patients, with primary immunodeficiencies and HIV, mainly in those with CD4 less than 200 cells/mcL.6 The majority present multifocal compromise, as in the case of the current patient, with a predominance in the spinal cord, epidural space, gastrointestinal tract and liver, upper respiratory tract, and skin, the latter organ having few cases reported in the literature and none in Colombia.1,3,4

Although its pathogenesis is poorly understood, it has been suggested that EBV infects smooth muscle cells directly by adhering to CD21 facilitating the replication of these cells.2 Other theories are based on the overexpression of the proto-oncogene MYC and the activation of the AkT/m TOR pathway triggered by the LMP2A protein, which promotes cell proliferation and tumor formation.7,8

The diagnosis is made based on physical examination, radiology, and findings in the histological and immunohistochemical study; it is confirmed with in situ hybridization study for the detection of the Epstein-Barr virus, as was done in the representative case.9 The presence of these lesions in the central nervous system has been associated with a worse prognosis; regarding treatment, there are some case reports of reversal of the neoplasms with the improvement of immunosuppression, surgical resection for isolated lesions have been published, and the use of radiotherapy and chemotherapy such as sirolimus.3 However, most reports are in patients without HIV infection and the results have not been completely satisfactory.1,10

Financial support

None declared.

Authors’ contributions

Estefania Galeano-Piedrahita: Approval of the final version of the manuscript; study conception and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.

Ana Maria Maya Rico: Approval of the final version of the manuscript; study conception and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.

Ana Cristina Ruiz Suárez: Approval of the final version of the manuscript; study conception and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.

Andrea Laverde Walter: Approval of the final version of the manuscript; study conception and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
J. Dekate, R. Chetty.
Epstein-Barr virus-associated smooth muscle tumor.
Arch Pathol Lab Med., 140 (2016), pp. 718-722
[2]
K.L. McClain, C.T. Leach, H.B. Jenson, V.V. Joshi, B.H. Pollock, R.T. Parmley, et al.
Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS.
N Engl J Med, 332 (1995), pp. 12-18
[3]
R. Issarachaikul, S. Shuangshoti, C. Suankratay.
Epstein-Barr virus-associated smooth muscle tumors in AIDS patients: a largest case (series).
Intern Med., 53 (2014), pp. 2391-2396
[4]
B. Purgina, U.N.M. Rao, M. Miettinen, L. Pantanowitz.
AIDS-related EBV-associated smooth muscle tumors: a review of 64 published cases.
Patholog Res Int., 2011 (2011), pp. 561548
[5]
K.P. Pritzker, S.N. Huang, K.G. Marshall.
Malignant tumours following immunosuppressive therapy.
Can Med Assoc J, 103 (1970), pp. 1362-1365
[6]
C. Suankratay, S. Shuangshoti, A. Mutirangura, V. Prasanthai, S. Lerdlum, S. Shuangshoti, et al.
Epstein-Barr virus infection-associated smooth-muscle tumors in patients with AIDS.
Clin Infect Dis., 40 (2005), pp. 1521-1528
[7]
H.B. Jenson, E.A. Montalvo, K.L. McClain, Y. Ench, P. Heard, B.A. Christy, et al.
Characterization of natural Epstein-Barr virus infection and replication in smooth muscle cells from a leiomyosarcoma.
J Med Virol., 57 (1999), pp. 36-46
[8]
C.A. Moody, R.S. Scott, N. Amirghahari, C.-A. Nathan, L.S. Young, C.W. Dawson, et al.
Modulation of the cell growth regulator mTOR by Epstein-Barr virus-encoded LMP2A.
J Virol., 79 (2005), pp. 5499-5506
[9]
H.-J. Delecluse, R. Feederle, B. O’Sullivan, P. Taniere.
Epstein Barr virus-associated tumours: an update for the attention of the working pathologist.
J Clin Pathol., 60 (2006), pp. 1358-1364
[10]
H.C. Toh, M. Teo, K.W. Ong, V. Lee, E. Chan, A.S. Lee, et al.
Use of sirolimus for Epstein-Barr virus-positive smooth-muscle tumour.
Lancet Oncol., 7 (2006), pp. 955-957

How to cite this article: Galeano-Piedrahita E, Rico AMM, Suárez ACR, Walter AL. Cutaneous smooth muscle tumors associated with Epstein Barr virus in an adult patient with HIV. An Bras Dermatol. 2021;96:184–7.

Study conducted at the CES University, Medellín, Antioquia, Colombia.

Copyright © 2021. Sociedade Brasileira de Dermatologia
Baixar PDF
Idiomas
Anais Brasileiros de Dermatologia (Portuguese)
Opções de artigo
Ferramentas
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.