Letter - Tropical/Infectious and parasitic dermatology
Nontuberculous mycobacteriosis (Mycobacterium chelonae): fatal outcome in a patient with severe systemic lupus erythematosus
Bárbara Elias do Carmo Barbosaa, Priscila Neri Lacerdaa, Luana Moraes Camposb, Mariângela Esther Alencar Marquesc, Silvio Alencar Marquesa, Luciana Patrícia Fernandes Abbadea,
Autor para correspondência
a Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
b Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
c Department of Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
Lido
4471
Vezesque se leu este artigo
1291
Total PDF
3180
Total HTML
Compartilhar estatÃsticas
array:23 [ "pii" => "S0365059623001587" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.12.005" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "813" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2023" "documento" => "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:18 [ "pii" => "S2666275223001911" "issn" => "26662752" "doi" => "10.1016/j.abdp.2023.06.025" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "813" "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 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas ‐ Tropical/Infectoparasitária</span>" "titulo" => "Micobacteriose não tuberculosa (<span class="elsevierStyleItalic">Mycobacterium chelonae</span>): desfecho fatal em paciente com lúpus eritematoso sistêmico grave" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "878" "paginaFinal" => "881" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1059 "Ancho" => 1675 "Tamanyo" => 410412 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histopatologia com detalhe para presença de bacilos álcool‐ácido resistentes (BAAR) formando agregados extracelulares (Ziehl Neelsen, 400<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bárbara Elias do Carmo Barbosa, Priscila Neri Lacerda, Luana Moraes Campos, Mariângela Esther Alencar Marques, Silvio Alencar Marques, Luciana Patrícia Fernandes Abbade" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Bárbara Elias do Carmo" "apellidos" => "Barbosa" ] 1 => array:2 [ "nombre" => "Priscila Neri" "apellidos" => "Lacerda" ] 2 => array:2 [ "nombre" => "Luana Moraes" "apellidos" => "Campos" ] 3 => array:2 [ "nombre" => "Mariângela Esther Alencar" "apellidos" => "Marques" ] 4 => array:2 [ "nombre" => "Silvio Alencar" "apellidos" => "Marques" ] 5 => array:2 [ "nombre" => "Luciana Patrícia Fernandes" "apellidos" => "Abbade" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059623001587" "doi" => "10.1016/j.abd.2022.12.005" "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/S0365059623001587?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001911?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000006/v1_202310100916/S2666275223001911/v1_202310100916/pt/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S0365059623001460" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.01.019" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "799" "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 - Therapy</span>" "titulo" => "Darier’s disease: treatment with topical sodium diclofenac 3% gel" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "882" "paginaFinal" => "884" ] ] "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" => 1840 "Ancho" => 3008 "Tamanyo" => 436156 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Dorsal region, four months after starting treatment. (B) Detail of the dorsal region, right scapular region after treatment</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcella Oliveira Menezes Quitete de Campos, Giovanna Abrantes Pimenta de Figueiredo, Allyson Capobiango Evangelista, Alexander Richard Bauk" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marcella Oliveira Menezes Quitete de" "apellidos" => "Campos" ] 1 => array:2 [ "nombre" => "Giovanna Abrantes Pimenta de" "apellidos" => "Figueiredo" ] 2 => array:2 [ "nombre" => "Allyson Capobiango" "apellidos" => "Evangelista" ] 3 => array:2 [ "nombre" => "Alexander Richard" "apellidos" => "Bauk" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223001789" "doi" => "10.1016/j.abdp.2023.06.014" "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/S2666275223001789?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001460?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000006/v2_202310301240/S0365059623001460/v2_202310301240/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059623001629" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.10.013" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "815" "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" => "Disseminated varicella with systemic implications in a renal transplant recipient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "875" "paginaFinal" => "878" ] ] "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" => 719 "Ancho" => 1555 "Tamanyo" => 252632 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0170" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Multinucleated cells with nuclear enlargement and ground-glass appearance (Tzanck cytology). (B) Enlarged multinucleated epithelial cells, with molded nuclei and “ground-glass” chromatin (Hematoxylin & eosin ×40)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ingrid Rocha Meireles Holanda, Marina Oliveira Dias, Rebecca Perez de Amorim, Aline Lutz Garcia, Ricardo Augusto Monteiro de Barros Almeida, Silvio Alencar Marques" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ingrid Rocha Meireles" "apellidos" => "Holanda" ] 1 => array:2 [ "nombre" => "Marina Oliveira" "apellidos" => "Dias" ] 2 => array:2 [ "nombre" => "Rebecca Perez de" "apellidos" => "Amorim" ] 3 => array:2 [ "nombre" => "Aline Lutz" "apellidos" => "Garcia" ] 4 => array:2 [ "nombre" => "Ricardo Augusto Monteiro de Barros" "apellidos" => "Almeida" ] 5 => array:2 [ "nombre" => "Silvio Alencar" "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223001935" "doi" => "10.1016/j.abdp.2023.06.027" "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/S2666275223001935?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001629?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000006/v2_202310301240/S0365059623001629/v2_202310301240/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Nontuberculous mycobacteriosis (<span class="elsevierStyleItalic">Mycobacterium chelonae</span>): fatal outcome in a patient with severe systemic lupus erythematosus" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "878" "paginaFinal" => "881" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Bárbara Elias do Carmo Barbosa, Priscila Neri Lacerda, Luana Moraes Campos, Mariângela Esther Alencar Marques, Silvio Alencar Marques, Luciana Patrícia Fernandes Abbade" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Bárbara Elias do Carmo" "apellidos" => "Barbosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Priscila Neri" "apellidos" => "Lacerda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Luana Moraes" "apellidos" => "Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Mariângela Esther Alencar" "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Silvio Alencar" "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:4 [ "nombre" => "Luciana Patrícia Fernandes" "apellidos" => "Abbade" "email" => array:1 [ 0 => "fernandes.abbade@unesp.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Pathology, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "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" => 1109 "Ancho" => 1675 "Tamanyo" => 265409 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0130" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of the erythematous-violaceous ulcerated nodules, with hematic necrotic crusts</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with systemic lupus erythematosus (SLE) presenting with skin lesions indicate a diagnostic challenge, as they may suggest disease activity, drug eruption, lupus vasculitis, and, more rarely, opportunistic infections.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Among the latter, non-tuberculous mycobacteria (NTM) or atypical mycobacteria constitutes an increasing cause of skin infections, especially in immunocompromised patients, including those with autoimmune diseases such as SLE.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This report describes a 37-year-old female patient, who had a previous diagnosis of SLE three years before, on methotrexate 15 mg/week, hydroxychloroquine 400 mg/day, and prednisone 15 mg/day, with no previous history of other immunosuppressive medications. She reported the appearance of skin lesions two months before. Dermatological examination showed erythematous-violaceous macules, papules and nodules (more palpable than visible), indurated, painful, some fistulized and with purulent exudate drainage, distributed on the medial surface of the right thigh (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">She was admitted for investigation of lupus activity and pulmonary thromboembolism (PTE) due to her poor general condition, hematological and respiratory alterations. During hospitalization, she developed fever peaks and was treated with cefepime, imipenem, and vancomycin with no improvement of the skin lesions and the systemic clinical picture.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The skin lesion exudate was sent for a culture of bacteria, fungi and mycobacteria and blood cultures were performed. All results were negative. Serologies for HIV, hepatitis B, hepatitis C and syphilis were non-reactive and bacilloscopy was negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A skin biopsy was performed and histopathology showed an epithelioid granulomatous inflammatory process surrounding a cystic necrotic cavity, containing neutrophils (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Ziehl-Neelsen staining showed acid-fast bacilli (AFB) in the cytoplasm of macrophages in the granulomatous process, suggesting nontuberculous mycobacteriosis (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Empirical treatment with rifampicin, ethambutol and azithromycin was initiated, but it was used for only two days, as the patient developed respiratory failure and died due to a thromboembolic event. There was no evidence of systemic mycobacterial infection (negative blood cultures).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The biopsy fragment was sent for culture and polymerase chain reaction (PCR) analysis at the Microbiology Laboratory of Instituto Lauro de Souza Lima. The culture showed the presence of fast-growing <span class="elsevierStyleItalic">Mycobacterium spp.</span> in five to six days. PCR was performed using the PCR-restriction enzyme analysis (PRA) technique, which consists of amplifying DNA with specific primers for a 441 bp sequence of the hsp65 gene. The PCR product was cleaved with the restriction enzymes <span class="elsevierStyleItalic">BstE</span>II and <span class="elsevierStyleItalic">Hae</span>III. The result of this analysis was released only after patient death and identified as <span class="elsevierStyleItalic">Mycobacterium chelonae</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">NTM infections are those caused by pathogenic mycobacteria other than <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> or <span class="elsevierStyleItalic">M. leprae</span>, and were formerly known as atypical, anonymous, opportunistic, or unclassified mycobacteriosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> NTM clinical presentation depends on the species of mycobacteria and can manifest as papules, plaques, nodules, abscesses and ulcers. Histopathological patterns may include non-specific findings of subcutaneous inflammation, abscesses, granulomas, and nodules.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The incidence of skin NTM infection has increased in recent decades due to the increased use of immunosuppressive therapy and better detection methods. Histopathological analysis is not species-specific, and some of the species are slow-growing and difficult to culture, making their diagnosis difficult. <a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A high index of suspicion for NTM infections is required in patients with SLE since the initial presentation can mimic several skin manifestations of lupus. The hypothesis should be considered in any patient with indolent skin lesions, especially if routine bacterial cultures are negative. Molecular investigation through polymerase chain reaction (PCR) can increase the sensitivity and specificity, but usually NTM is a late diagnosis and therapy will vary depending on the causative agent.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Almost all species of mycobacteria already identified are capable of causing infection of the skin and subcutaneous tissue, with the main isolated agents being <span class="elsevierStyleItalic">M. fortuitum</span>, <span class="elsevierStyleItalic">M. abscessus</span>, <span class="elsevierStyleItalic">M. chelonae</span>, <span class="elsevierStyleItalic">M. marinum</span>, <span class="elsevierStyleItalic">and M. ulcerans. M. chelonae,</span> isolated in the present case, is found in aquatic environments, soil, and surgical instruments and is characterized by rapid growth in culture. Localized infections have been reported associated with tattoos, pedicure and cosmetic procedures. Disseminated infection usually occurs in immunocompromised individuals, predominantly affecting the lower extremities.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The best therapeutic options described for <span class="elsevierStyleItalic">M. chelonae</span> are tobramycin, imipenem, clarithromycin, linezolid and cotrimoxazole. Regardless of the choice of antibiotics, therapy can last for months to over a year. Surgical intervention may also be employed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A fatal outcome associated with a thromboembolic phenomenon shortly after starting multidrug therapy may be a consequence of a severe infection itself, related to SLE, as well as an adverse event caused by newly introduced drugs, especially rifampicin. Rifampicin-induced coagulopathy is a rare complication, but its influence cannot be ruled out in the present report.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It is noteworthy that the patient had a previous episode of pulmonary thromboembolism but with negative anticardiolipin, IgM and IgG lupus anticoagulant autoantibodies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This case report aimed to highlight the need to suspect the diagnosis of infections caused by NTM, as opportunistic infections are on the rise in our country. It is also important to warn about the difficulty related to the culture of these microorganisms and the high morbidity and mortality of this disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Bárbara Elias do Carmo Barbosa: Drafting and editing of the manuscript; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Priscila Neri Lacerda: Drafting and editing of the manuscript; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Luana Moraes Campos: Drafting and editing of the manuscript; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Mariângela Esther Alencar Marques: Drafting and editing of the manuscript; effective participation in research orientation; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Silvio Alencar Marques: Drafting and editing of the manuscript; effective participation in research orientation; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Luciana Patrícia Fernandes Abbade: Drafting and editing of the manuscript; effective participation in research orientation; effective participation in propaedeutics; literature review; critical review of the manuscript; approval of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 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:2 [ "identificador" => "xack698988" "titulo" => "Acknowledgment" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-10-14" "fechaAceptado" => "2022-12-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1109 "Ancho" => 1675 "Tamanyo" => 176847 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0125" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous ulcerated macules and nodules, some covered by hematic crusts, located on the medial surface of the right thigh</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" => 1109 "Ancho" => 1675 "Tamanyo" => 265409 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0130" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of the erythematous-violaceous ulcerated nodules, with hematic necrotic crusts</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" => 2345 "Ancho" => 1675 "Tamanyo" => 828649 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0135" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathological analysis. (A) Neutrophilic granulomatous inflammatory process, with superficial and deep involvement of the dermis (Hematoxylin & eosin, ×200). (B) Epithelioid granulomatous inflammatory process surrounding a cystic necrotic cavity containing neutrophils and cell debris (Hematoxylin & eosin, ×400)</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" => 1059 "Ancho" => 1675 "Tamanyo" => 410412 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histopathological analysis: detail showing the presence of acid-fast bacilli (AFB) forming extracellular aggregates (Ziehl Neelsen, ×400)</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus erythematosus: Significance of dermatologic findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Lenormand" 1 => "D. Lipsker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annder.2020.08.052" "Revista" => array:7 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2021" "volumen" => "148" "paginaInicial" => "6" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33483145" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1474442211701090" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic lupus erythematosus and infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.K. Singh" 1 => "S. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4081/reumatismo.2020.1303" "Revista" => array:6 [ "tituloSerie" => "Reumatismo" "fecha" => "2020" "volumen" => "72" "paginaInicial" => "154" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33213128" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-tuberculous cutaneous mycobacterioses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.B. Nogueira" 1 => "C.N. Garcia" 2 => "M.S.C.D. Costa" 3 => "M.B. Moraes" 4 => "P.S. Kurizky" 5 => "C.M. Gomes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.abd.2021.04.005" "Revista" => array:7 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2021" "volumen" => "96" "paginaInicial" => "527" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34275692" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S096758681300194X" "estado" => "S300" "issn" => "09675868" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous non- tuberculous Mycobacterial infections: a clinical and histopathological study of 17 cases from Lebanon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Abbas" 1 => "N. Marrouch" 2 => "M.M. Kattar" 3 => "S. Zeynoun" 4 => "A.G. Kibbi" 5 => "R.A. Rached" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "33" "paginaFinal" => "42" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous infections due to nontuberculosis mycobacterium: recognition and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Chung" 1 => "D. Ince" 2 => "B.A. Ford" 3 => "K.A. Wanat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40257-018-0382-5" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2018" "volumen" => "19" "paginaInicial" => "867" "paginaFinal" => "878" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30168084" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nontuberculous mycobacterial infections of the skin: a retrospective study of 25 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Dodiuk-Gad" 1 => "P. Dyachenko" 2 => "M. Ziv" 3 => "A. Shani-Adir" 4 => "Y. Oren" 5 => "S. Mendelovici" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "413" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mycobacterium chelonae cutaneous infection in apatient with mixed connective tissue disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Lage" 1 => "D.G.Z. Biccigo" 2 => "F.B.C. Santos" 3 => "E. Chimara" 4 => "E.S.P. Pereira" 5 => "A. DaCosta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20153545" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2015" "volumen" => "90" "paginaInicial" => "104" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26312688" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case of atypical cutaneous Mycobacterium chelonae infection in patient of systemic lupus erythematosus after cyclophosphamide therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Rasool" 1 => "A. Afifi" 2 => "D. De Lord" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "e231930" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deranged haemostasis: rifampin-induced coagulopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Tiperneni" 1 => "F. Khalid" 2 => "H. Fichadiya" 3 => "A. Al-Alwan" 4 => "G. Mohan" 5 => "F. Heis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12890/2022_003380" "Revista" => array:5 [ "tituloSerie" => "Eur J Case Rep Intern Med" "fecha" => "2022" "volumen" => "9" "paginaInicial" => "003380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35774731" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack698988" "titulo" => "Acknowledgment" "texto" => "<p id="par0110" class="elsevierStylePara elsevierViewall">The authors would like to thank photographer Eliete Correia Soares for the photographs of the patient and researcher Ida Maria Foschiani Dias Baptista from the Microbiology laboratory of Instituto Lauro de Souza Lima.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000006/v2_202310301240/S0365059623001587/v2_202310301240/en/main.assets" "Apartado" => array:4 [ "identificador" => "95150" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter - Tropical/Infectious and parasitic dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000006/v2_202310301240/S0365059623001587/v2_202310301240/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001587?idApp=UINPBA00008Z" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 46 | 6 | 52 |
| 2024 Outubro | 237 | 74 | 311 |
| 2024 Setembro | 245 | 82 | 327 |
| 2024 Agosto | 299 | 122 | 421 |
| 2024 Julho | 246 | 103 | 349 |
| 2024 Junho | 173 | 67 | 240 |
| 2024 Maio | 190 | 74 | 264 |
| 2024 Abril | 128 | 88 | 216 |
| 2024 Março | 106 | 63 | 169 |
| 2024 Fevereiro | 98 | 86 | 184 |
| 2024 Janeiro | 112 | 58 | 170 |
| 2023 Dezembro | 627 | 81 | 708 |
| 2023 Novembro | 245 | 115 | 360 |
| 2023 Outubro | 253 | 111 | 364 |
| 2023 Setembro | 69 | 75 | 144 |
| 2023 Agosto | 49 | 39 | 88 |
| 2023 Julho | 57 | 47 | 104 |
Mostrar tudo
