Letter - Clinical
Langerhans cell histiocytosis: a rare case of the multisystemic form in an infant
Thaís Oliveira Utiyama
, Maria Laura Malzoni, Thalita Gabrieli Sanches Vasques, Cassiano Tamura Vieira Gomes
Autor para correspondência
Faculty of Medical and Health Sciences of Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil
Lido
3719
Vezesque se leu este artigo
1445
Total PDF
2274
Total HTML
Compartilhar estatÃsticas
array:22 [ "pii" => "S036505962300003X" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.06.011" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "702" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:17 [ "pii" => "S2666275223000279" "issn" => "26662752" "doi" => "10.1016/j.abdp.2023.01.010" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "702" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas ‐ Caso clínico</span>" "titulo" => "Histiocitose de células de Langerhans: caso raro de forma multissistêmica em lactente" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "395" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1796 "Ancho" => 1675 "Tamanyo" => 443768 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatite crônica associada à presença de células sugestivas de células de Langerhans (Hematoxilina & eosina, × 400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Thaís Oliveira Utiyama, Maria Laura Malzoni, Thalita Gabrieli Sanches Vasques, Cassiano Tamura Vieira Gomes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Thaís Oliveira" "apellidos" => "Utiyama" ] 1 => array:2 [ "nombre" => "Maria Laura" "apellidos" => "Malzoni" ] 2 => array:2 [ "nombre" => "Thalita Gabrieli Sanches" "apellidos" => "Vasques" ] 3 => array:2 [ "nombre" => "Cassiano Tamura Vieira" "apellidos" => "Gomes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962300003X" "doi" => "10.1016/j.abd.2021.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300003X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000279?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000003/v3_202305121556/S2666275223000279/v3_202305121556/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059623000089" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.04.010" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "707" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Morphea after SARS-CoV2 vaccine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "396" "paginaFinal" => "398" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1551 "Ancho" => 2508 "Tamanyo" => 419305 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Symmetrical, whitish, ivory, xerotic and sclerotic plaques, with a diameter ≥3 cm. (B) Whitish and sclerotic skin plaque with a “cigarette-paper” appearance on the patient's back.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Giovanni Paolino, Matteo Riccardo Di Nicola, Nathalie Rizzo, Santo Raffaele Mercuri" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Paolino" ] 1 => array:2 [ "nombre" => "Matteo Riccardo" "apellidos" => "Di Nicola" ] 2 => array:2 [ "nombre" => "Nathalie" "apellidos" => "Rizzo" ] 3 => array:2 [ "nombre" => "Santo Raffaele" "apellidos" => "Mercuri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000334" "doi" => "10.1016/j.abdp.2023.02.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000334?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000089?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000089/v3_202305121633/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S036505962200318X" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.07.010" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "697" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Kaposiform hemangioendothelioma and tufted angioma: two entities of the same clinicopathological spectrum" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "391" "paginaFinal" => "394" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1369 "Ancho" => 2925 "Tamanyo" => 672768 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathological features of tufted angioma (TA). (A) Vascular proliferation in the papillary and medium dermis; nodules were composed of tufted vascular vessels lined with endothelial cells. These endothelial cells were fVIII, CD31 and CD34 positive (podoplanin negative). (B) These nodules were surrounded at the periphery by semilunar vascular spaces (podoplanin positive).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lula María Nieto-Benito, Jorge Huerta-Aragonés, Verónica Parra-Blanco, Minia Campos-Domínguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Lula María" "apellidos" => "Nieto-Benito" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Huerta-Aragonés" ] 2 => array:2 [ "nombre" => "Verónica" "apellidos" => "Parra-Blanco" ] 3 => array:2 [ "nombre" => "Minia" "apellidos" => "Campos-Domínguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S266627522300022X" "doi" => "10.1016/j.abdp.2023.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522300022X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962200318X?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S036505962200318X/v3_202305121633/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Langerhans cell histiocytosis: a rare case of the multisystemic form in an infant" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "395" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Thaís Oliveira Utiyama, Maria Laura Malzoni, Thalita Gabrieli Sanches Vasques, Cassiano Tamura Vieira Gomes" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Thaís Oliveira" "apellidos" => "Utiyama" "email" => array:1 [ 0 => "thaisutiyama@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Maria Laura" "apellidos" => "Malzoni" ] 2 => array:2 [ "nombre" => "Thalita Gabrieli Sanches" "apellidos" => "Vasques" ] 3 => array:2 [ "nombre" => "Cassiano Tamura Vieira" "apellidos" => "Gomes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculty of Medical and Health Sciences of Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 978 "Ancho" => 1675 "Tamanyo" => 270767 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive immunohistochemistry for CD1a.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Langerhans cell histiocytosis (LCH) is an inflammatory neoplasm of myeloid precursor cells, in which there is an accumulation of specialized dendritic cells in different organs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case report describes a rare case of LCH with a multisystemic presentation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This case describes a two-month-old male patient, presenting erythematous-purpuric lesions scattered throughout the body since birth. After a short period of apparent improvement, the lesions recurred. There were no systemic manifestations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On physical examination, angiomatous papules with hematic crusts on top and some flat, hypochromic, shiny papules were observed, also affecting the palmoplantar region and the oral cavity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore, the diagnostic hypotheses of LCH, congenital cytomegalovirus (CMV), leukemia cutis, and severe combined immunodeficiency were suggested. A biopsy was performed, and serologies were requested (HIV, CMV, rubella, toxoplasmosis, VDRL) which were negative, whereas screening for congenital immunodeficiency showed no alterations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Histopathology revealed chronic dermatitis associated with the presence of cells suggestive of Langerhans cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry showed positivity for CD1a, CD68, S100 protein; Ki67 was positive in 70% of the cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Once the diagnosis of LCH was confirmed, the investigation of other organs through a myelogram and computed tomography of the chest, abdomen, and pelvis led to the classification of the case as multisystemic LCH due to pulmonary and hepatic involvement. Treatment was started with weekly vinblastine 3 mg/m<span class="elsevierStyleSup">2</span> + prednisone 20 mg/m<span class="elsevierStyleSup">2</span>, according to the <span class="elsevierStyleItalic">Brazilian Society of Histiocytosis</span> guideline. The condition improved significantly, but after about two months the skin lesions returned, and the pulmonary condition worsened, requiring oxygen therapy. A new chemotherapy regimen with Cladribine (2-CdA) was introduced, according to the Japanese protocol. The patient remains stable and is being followed by the oncology team.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The incidence of LCH ranges from two to nine cases per million children under 15 years of age, with a peak between one and three years of age.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It can affect one or multiple organs, with the following being considered at risk: liver, spleen, and bone marrow. Most patients have single-system involvement (70%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The most frequently affected organs are the bones, followed by the skin, but in infants, cutaneous manifestations are the main findings. Dermatologically, they present as a seborrheic-like dermatitis, and less often as hemorrhagic lesions, although these are favorable conducive to diagnosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The pathogenesis remains unclear, with theories that support both a reactional and a neoplastic nature. Characterization as a neoplastic disorder is supported by the finding of a mutation in the BRAF V600E gene, and activation of the MAP kinase (MAPK) pathway.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis depends on the clinical, anatomopathological and immunohistochemical correlation. Histopathologically, varying amounts of Langerhans cells with a “coffee bean” appearance are observed. Positive immunohistochemistry for CD1a and CD207 (langerin) establishes the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment will depend on disease extent and severity. When the involvement is solely cutaneous, spontaneous resolution is common. For multisystem disease, treatment with systemic steroids and vinblastine for 12 months is the first-line regimen.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">LCH is a serious disease that, due to its very diverse clinical manifestation, is often diagnosed late, delaying treatment. The presence of a dermatologist in the clinical staff allows its early identification, with a significant impact on patient prognosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Thaís Oliveira Utiyama: Drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Maria Laura Malzoni: Effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; approval of the final version of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Thalita Gabrieli Sanches Vasques: Critical review of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Cassiano Tamura Vieira Gomes: Approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-05-12" "fechaAceptado" => "2021-06-05" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Faculty of Medical and Health Sciences of Sorocaba, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2240 "Ancho" => 1675 "Tamanyo" => 307126 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Angiomatous papules with hematic crusts on top and some flat, hypochromic papules, with a shiny appearance on the trunk.</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" => 1796 "Ancho" => 1675 "Tamanyo" => 443768 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chronic dermatitis associated with the presence of cells suggestive of Langerhans cells (Hematoxylin & eosin 100X).</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" => 978 "Ancho" => 1675 "Tamanyo" => 270767 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positive immunohistochemistry for CD1a.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis in children: History, classification, pathobiology, clinical manifestations, and prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Krooks" 1 => "M. Minkov" 2 => "A.G. Weatherall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.05.059" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "1035" "paginaFinal" => "1044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29754885" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood Langerhans cell histiocytosis: a disease with many faces" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.K.C. Leung" 1 => "J.M. Lam" 2 => "K.F. Leong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "World J Pediatr" "fecha" => "2019" "volumen" => "15" "paginaInicial" => "536" "paginaFinal" => "545" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diverse cutaneous manifestation of Langerhans cell histiocytosis: a 10-year retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Poompuen" 1 => "J. Chaiyarit" 2 => "L. Techasatian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00431-019-03356-1" "Revista" => array:6 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "2019" "volumen" => "178" "paginaInicial" => "771" "paginaFinal" => "776" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30826864" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis: progress and controversies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. Abla" 1 => "B. Rollins" 2 => "S. Ladisch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.16099" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2019" "volumen" => "187" "paginaInicial" => "559" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31309539" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis in children: Diagnosis, differential diagnosis, treatment, sequelae, and standardized follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Krooks" 1 => "M. Minkov" 2 => "A.G. Weatherall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.05.060" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "1047" "paginaFinal" => "1056" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29754886" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000003/v3_202305121633/S036505962300003X/v3_202305121633/en/main.assets" "Apartado" => array:4 [ "identificador" => "95691" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter – Clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000003/v3_202305121633/S036505962300003X/v3_202305121633/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300003X?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 22 | 7 | 29 |
| 2024 Outubro | 134 | 79 | 213 |
| 2024 Setembro | 189 | 101 | 290 |
| 2024 Agosto | 189 | 122 | 311 |
| 2024 Julho | 141 | 95 | 236 |
| 2024 Junho | 104 | 67 | 171 |
| 2024 Maio | 108 | 74 | 182 |
| 2024 Abril | 105 | 78 | 183 |
| 2024 Março | 108 | 64 | 172 |
| 2024 Fevereiro | 125 | 77 | 202 |
| 2024 Janeiro | 66 | 52 | 118 |
| 2023 Dezembro | 85 | 64 | 149 |
| 2023 Novembro | 85 | 98 | 183 |
| 2023 Outubro | 83 | 87 | 170 |
| 2023 Setembro | 85 | 77 | 162 |
| 2023 Agosto | 97 | 33 | 130 |
| 2023 Julho | 100 | 41 | 141 |
| 2023 Junho | 153 | 64 | 217 |
| 2023 Maio | 133 | 71 | 204 |
| 2023 Abril | 84 | 13 | 97 |
| 2023 Março | 37 | 48 | 85 |
| 2023 Fevereiro | 41 | 33 | 74 |
Mostrar tudo
