Letter – Tropical/Infectious and parasitic dermatology
Urban chromoblastomycosis: a diagnosis that should not be neglected
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(A) Hifas acastanhadas septadas (Borelli <span class="elsevierStyleItalic">spider</span>). Exame micológico direto, KOH 20% + DMSO, 40×. (B) Micromorfologia evidenciando hifas acastanhadas, septadas, de onde partem conidióforos com conídios alongados em sua extremidade, dando aspecto de cajado nodoso. <span class="elsevierStyleItalic">Rhinocladiella</span> sp., lactofenol, 40×.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jessica Lana Conceição e Silva Baka, Gabriela Giraldelli, Andrea Reis Bernardes‐Engemann, Carlos Baptista Barcaui, Rosane Orofino‐Costa" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Jessica Lana Conceição e Silva" "apellidos" => "Baka" ] 1 => array:2 [ "nombre" => "Gabriela" "apellidos" => "Giraldelli" ] 2 => array:2 [ "nombre" => "Andrea Reis" "apellidos" => "Bernardes‐Engemann" ] 3 => array:2 [ "nombre" => "Carlos Baptista" "apellidos" => "Barcaui" ] 4 => array:2 [ "nombre" => "Rosane" "apellidos" => "Orofino‐Costa" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059623000077" "doi" => "10.1016/j.abd.2022.01.013" "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/S0365059623000077?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000322?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000003/v3_202305121556/S2666275223000322/v3_202305121556/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059623000223" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.12.001" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "719" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "On the recurrence rate of cutaneous tumors treated exclusively by micrographic surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "426" "paginaFinal" => "427" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luiz Eduardo Fabrício de Melo Garbers, Ana Carolina Miola, Luis Fernando Figueiredo Kopke, Hélio Amante Miot" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luiz Eduardo Fabrício de Melo" "apellidos" => "Garbers" ] 1 => array:2 [ "nombre" => "Ana Carolina" "apellidos" => "Miola" ] 2 => array:2 [ "nombre" => "Luis Fernando Figueiredo" "apellidos" => "Kopke" ] 3 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000462" "doi" => "10.1016/j.abdp.2023.02.018" "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/S2666275223000462?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000223?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000223/v3_202305121633/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059623000168" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.04.014" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "720" "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 - Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Mutilating localized cutaneous leishmaniasis caused by <span class="elsevierStyleItalic">Leishmania guyanensis</span>" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "419" "paginaFinal" => "421" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1211 "Ancho" => 1675 "Tamanyo" => 449995 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathological examination. Hematoxylin & eosin, ×1000. Granulomatous inflammation consisting of plasmocytes, lymphocytes, histiocytes, epithelioid cells, and the presence of rare amastigotes (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dina Fabrício da Silva, Sidharta Quercia Gadelha, Andréa de Souza Cavalcante, Rosilene Viana de Andrade, Jorge Augusto de Oliveira Guerra, Alcidarta dos Reis Gadelha" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Dina Fabrício da" "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Sidharta Quercia" "apellidos" => "Gadelha" ] 2 => array:2 [ "nombre" => "Andréa de Souza" "apellidos" => "Cavalcante" ] 3 => array:2 [ "nombre" => "Rosilene Viana de" "apellidos" => "Andrade" ] 4 => array:2 [ "nombre" => "Jorge Augusto de Oliveira" "apellidos" => "Guerra" ] 5 => array:2 [ "nombre" => "Alcidarta dos Reis" "apellidos" => "Gadelha" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000474" "doi" => "10.1016/j.abdp.2023.02.019" "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/S2666275223000474?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000168?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000168/v3_202305121633/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter – Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Urban chromoblastomycosis: a diagnosis that should not be neglected" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "422" "paginaFinal" => "425" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jessica Lana Conceição e Silva Baka, Gabriela Giraldelli, Andrea Reis Bernardes-Engemann, Carlos Baptista Barcaui, Rosane Orofino-Costa" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Jessica Lana Conceição e Silva" "apellidos" => "Baka" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Gabriela" "apellidos" => "Giraldelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Andrea Reis" "apellidos" => "Bernardes-Engemann" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Carlos Baptista" "apellidos" => "Barcaui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "Rosane" "apellidos" => "Orofino-Costa" "email" => array:1 [ 0 => "rosaneorofino@icloud.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Service of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Laboratory of Mycology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1536 "Ancho" => 3175 "Tamanyo" => 352027 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. (A) Septate, brownish hyphae (“Borelli spiders”). Direct microscopy, KOH 20% + DMSO, ×40. (B) Colony micromorphology showing brownish, septate hyphae, from which conidiophores with elongated conidia at their extremities arise, giving the appearance of a gnarled staff. <span class="elsevierStyleItalic">Rhinocladiella</span> spp., lactophenol, ×40.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chromoblastomycosis, a neglected disease with a strong rural profile, is caused by melanized geophilic fungi. Infection occurs after traumatic inoculation into the skin, and <span class="elsevierStyleItalic">Fonsecaea pedrosoi</span> is the most common agent.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This case report describes two cases of chromoblastomycosis in inhabitants of an urban area, and their epidemiological and therapeutic data.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case reports</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleEnunciation" id="enun0005"><span class="elsevierStyleLabel">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 69-year-old healthy male physician who lives in the southern zone of the municipality of Rio de Janeiro reported that after falling from his bicycle during a tropical storm in Parque Lage, an urban forest inside the city of Rio de Janeiro, an open wound appeared on his right knee, caused by trauma from a tree branch. The lesion was a plaque with a verrucous appearance, well-defined borders and small satellite lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></p><p id="par0020" class="elsevierStylePara elsevierViewall">Direct mycological examination (DME) showed brownish hyphae (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) in addition to muriform bodies, and <span class="elsevierStyleItalic">Rhinocladiella spp.</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B) was isolated in the culture.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">He underwent surgical excision of the lesion with wide margins. Two weeks before the intervention, itraconazole 200<span class="elsevierStyleHsp" style=""></span>mg/day was started for six months, followed by 100<span class="elsevierStyleHsp" style=""></span>mg/day for four months. There was no recurrence or complications after three years of follow-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<span class="elsevierStyleEnunciation" id="enun0010"><span class="elsevierStyleLabel">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 67-year-old male patient who lived in the northern zone of the municipality of Rio de Janeiro worked as a manager. Currently, he presented with diabetes mellitus and systemic arterial hypertension, taking losartan, atenolol and metformin. A year ago, a papule appeared on his right calf, progressing into ulceration with purulent discharge (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). He was treated with topical and systemic antibiotics, and topical antifungals and corticosteroids, with no improvement. He denied previous trauma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></p><p id="par0035" class="elsevierStylePara elsevierViewall">DME was positive for chromoblastomycosis, and <span class="elsevierStyleItalic">Fonsecaea spp.</span> was isolated in the culture. Itraconazole 200<span class="elsevierStyleHsp" style=""></span>mg/day was started. Two months later, satellite lesions were observed, as well as lesion enlargement. Wide surgical excision was performed, with the maintenance of oral itraconazole for eight months. There was no recurrence after eight months of follow-up (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion and conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Although 90% of cases of chromoblastomycosis are described in individuals with rural activities,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a> the two patients described herein did not report this type of activity.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Around the world, there are still cities with preserved native nature, such as the Floresta da Tijuca, the largest urban forest in the world, located in the municipality of Rio de Janeiro. The search for healthy outdoor activities is becoming increasingly frequent in urban centers and diseases related to nature agents must be taken into account in the differential diagnosis, including chromoblastomycosis mainly the verrucous lesions. The location and size of the lesions suggested the moderate verrucous type of the disease in both cases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The isolation of <span class="elsevierStyleItalic">Rhinocladiella spp.</span> is another unusual finding since there are few published reports of this species in Brazil.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a> The presence of hyphae in DME may indicate greater potential for invasion with the production of pro-inflammatory cytokines (TNF-α, IL1-β, IL-6).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The best treatment approach is to combine an oral antifungal initially, most often itraconazole, with extensive surgical excision.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9,10</span></a> Cryosurgery is another recommended adjunctive treatment.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,10</span></a> These two patients were cured with no recurrence and no impairment of their social and professional lives.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The authors intend to emphasize the importance of the differential diagnosis in patients with urban activity in case of diseases linked to rural activity, preventing unnecessary treatments and chronicity. Attention to the clinical and laboratory diagnosis and the early treatment can increase the chances of cure.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Jessica Lana Conceição and Silva Baka: Design and planning of the study; drafting of the original version; editing and critical review of the manuscript; participation in the therapeutic conduct; critical review of the literature and manuscript; approval of the final version of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Gabriela Giraldelli: Design and planning of the study; drafting of the original version; editing and critical review of the manuscript; participation in the therapeutic conduct; critical review of the literature and manuscript; approval of the final version of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Andrea Reis Bernardes-Engemann: Design and planning of the study; drafting of the original version; editing and critical review of the manuscript; participation in the therapeutic conduct; critical review of the literature and manuscript; approval of the final version of the manuscript; effective participation in research orientation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Carlos Baptista Barcaui: Design and planning of the study; drafting of the original version; editing and critical review of the manuscript; participation in the therapeutic conduct; critical review of the literature and manuscript; approval of the final version of the manuscript; effective participation in research orientation.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Rosane Orofino-Costa: Design and planning of the study; drafting of the original version; editing and critical review of the manuscript; participation in the therapeutic conduct; critical review of the literature and manuscript; approval of the final version of the manuscript; effective participation in research orientation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case reports" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion and conclusion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-12-09" "fechaAceptado" => "2022-01-18" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Dermatology Department, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 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" => 1840 "Ancho" => 3175 "Tamanyo" => 518432 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. (A) Asymptomatic verrucous plaque, measuring approximately 5.0<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.0<span class="elsevierStyleHsp" style=""></span>cm, with well-defined borders, and small areas intermingled with blackened dots and satellite lesions, located on the extensor surface of the right knee. (B) Three years after surgical excision with safety margins, both superficial and deep.</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" => 1536 "Ancho" => 3175 "Tamanyo" => 352027 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. (A) Septate, brownish hyphae (“Borelli spiders”). Direct microscopy, KOH 20% + DMSO, ×40. (B) Colony micromorphology showing brownish, septate hyphae, from which conidiophores with elongated conidia at their extremities arise, giving the appearance of a gnarled staff. <span class="elsevierStyleItalic">Rhinocladiella</span> spp., lactophenol, ×40.</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" => 2131 "Ancho" => 3175 "Tamanyo" => 976800 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 2. (A) An infiltrated, well-delimited plaque, with ulceration and purulent background, measuring approximately 5.0<span class="elsevierStyleHsp" style=""></span>cm, on the posterior right calf and a nearby verrucous lesion, measuring approximately 0.5<span class="elsevierStyleHsp" style=""></span>cm; (B) Eight months after follow-up.</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" => "Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Brito" 1 => "M.J.S. 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