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colchicine&#44; Nonsteroidal Anti-inflammatory Drugs &#40;NSAIDs&#41;&#44; and hydroxychloroquine&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Corticosteroids has a moderate effect and antihistamine therapy has no effect&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> According to Simon et al&#46;&#44; the efficacy of colchicine is only 25&#37;&#44; but based on the benefit&#47;risk ratio&#44; colchicine is recommended as the first choice of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Experts recommend the use of anakinra &#40;IL-1 block&#41; in more symptomatic patients&#44; such as Erythrocyte Sedimentation Rate &#40;ESR&#41; and CRP above the upper limit of normal &#40;CRP&#8239;&#62;&#8239;3&#8239;mg&#47;dL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment with corticosteroids&#44; NSAIDs&#44; and antihistamines is symptomatic and unsatisfactory&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Anakinra &#40;IL-1-neutralizing&#41; is the choice drug&#46; The effect of inhibition of IL-1 has led to new expectations&#44; but there is currently unavailable in Brazil&#46; An alternative drug could be canakinumab&#44; a human anti-IL-1&#946; monoclonal antibody aiming at the neutralization of 1&#946; signaling&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In patients presenting with chronic urticaria associated with signs of systemic inflammation&#44; this rare and debilitating syndrome should be considered&#46; Early treatment can improve patient&#39;s quality of life and disease prognosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Kelielson Cardoso de Mac&#234;do Cruz&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#59; critical literature review&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Daniela de Abreu e Silva Martinez&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Danielle Carvalho Quintella&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tullia Cuzzi&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sergio Duarte Dortas Junior&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Solange Oliveira Rodrigues Valle&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#46;</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&#46;</p></span></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Obligate criteria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">- Chronic urticarial rash and&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">- Recurrent fever<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>POEMS syndrome &#40;polyneuropathy&#44; organomegaly&#44; endocrinopathy&#44; mono-clonal gammopathy and skin changes&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic Spontaneous Urticaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypocomplementemic urticarial vasculitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beh&#231;et syndrome&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mastocytosis&nbsp;\t\t\t\t\t\t\n
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Letter - Clinical
Mimicking urticaria: a Schnitzler syndrome case
Kelielson Cardoso de Macêdo Cruza,
Autor para correspondência
kelielsoncma@gmail.com

Corresponding author.
, Daniela de Abreu e Silva Martineza, Danielle Carvalho Quintellab, Tullia Cuzzib, Sergio Duarte Dortas Juniora, Solange Oliveira Rodrigues Vallea
a Department of Immunology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
b Department of Pathology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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not painful&#44; urticaria-like lesions on the extremities and the trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesions resolved within 24&#8239;hours without leaving behind dusky hyperpigmentation&#46; He had intermittent fever of up to 39&#8239;&#176;C&#44; generalized arthralgia&#44; and fatigue&#46; The inflammatory episodes lasted for 2&#8211;5 days with severe general impairment&#46; The patient suffered outbreaks with variable intensity on almost a monthly basis over the past fifteen years&#46; Histopathology of lesional skin showed a perivascular and interstitial polymorphonuclear infiltrate&#44; described as consistent with the diagnosis of urticarial lesions and compatible with SchS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory investigations revealed leucocytosis &#40;up to 21&#46;000&#8239;mm<span class="elsevierStyleSup">3</span>&#44; ref 4000&#8211;11600&#8239;mm<span class="elsevierStyleSup">3</span>&#41;&#44; an elevated ESR &#40;120&#8239;mm&#47;hr&#59; 0&#8764;20&#8239;mm&#47;hr&#41;&#44; and increased IgM levels &#40;2550&#8239;mg&#47;dL&#59; 46&#8764;260&#8239;mg&#47;dL&#41; in serum protein electrophoresis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; In the bone scan&#44; there is a slight asymmetry of uptake in the tibias&#44; slightly greater on the left&#46; Bone marrow biopsy was performed with a negative cytogenetic study for lymphoproliferative diseases&#46; Based on these clinical and laboratory findings&#44; he was diagnosed with Schnitzler Syndrome&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">He was started on a high-dose corticosteroid&#44; NSAIDs&#44; and antihistamines with partial remission of his symptoms&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There are a few cases reported in Latin America and in general&#44; it is underdiagnosed despite the well-established diagnostic criteria&#44; but the pathogenesis is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The major complication is hematological malignancy&#44; with lymphoproliferative disorder occurring in about 10&#37;&#8210;20&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> In addition to chronic spontaneous urticaria&#44; other differential diagnoses should be considered &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">At present&#44; for patients with CRP&#8239;&#60;&#8239;3&#8239;mg&#47;dL&#44; treatment options include&#44; colchicine&#44; Nonsteroidal Anti-inflammatory Drugs &#40;NSAIDs&#41;&#44; and hydroxychloroquine&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Corticosteroids has a moderate effect and antihistamine therapy has no effect&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> According to Simon et al&#46;&#44; the efficacy of colchicine is only 25&#37;&#44; but based on the benefit&#47;risk ratio&#44; colchicine is recommended as the first choice of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Experts recommend the use of anakinra &#40;IL-1 block&#41; in more symptomatic patients&#44; such as Erythrocyte Sedimentation Rate &#40;ESR&#41; and CRP above the upper limit of normal &#40;CRP&#8239;&#62;&#8239;3&#8239;mg&#47;dL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment with corticosteroids&#44; NSAIDs&#44; and antihistamines is symptomatic and unsatisfactory&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Anakinra &#40;IL-1-neutralizing&#41; is the choice drug&#46; The effect of inhibition of IL-1 has led to new expectations&#44; but there is currently unavailable in Brazil&#46; An alternative drug could be canakinumab&#44; a human anti-IL-1&#946; monoclonal antibody aiming at the neutralization of 1&#946; signaling&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In patients presenting with chronic urticaria associated with signs of systemic inflammation&#44; this rare and debilitating syndrome should be considered&#46; Early treatment can improve patient&#39;s quality of life and disease prognosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Kelielson Cardoso de Mac&#234;do Cruz&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#59; critical literature review&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Daniela de Abreu e Silva Martinez&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Danielle Carvalho Quintella&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tullia Cuzzi&#58; Preparation and writing of the manuscript&#59; approval of the final version of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sergio Duarte Dortas Junior&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Solange Oliveira Rodrigues Valle&#58; Preparation and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; approval of the final version of the manuscript&#46;</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&#46;</p></span></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Objective findings of abnormal bone remodeling with or without bone pain<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- A neutrophilic dermal infiltrate on skin biopsy<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Leukocytosis and&#47;or elevated CRP<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Definite diagnosis if&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">- Two obligate criteria AND at least two minor criteria if IgM and three minor criteria if IgG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Probable diagnosis if&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">- Two obligate criteria AND at least one minor criteria if IgM and two minor criteria if IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Must be &#62;38&#8239;&#176;C and otherwise unexplained&#46; Occurs usually &#8210; but not obligatory &#8210; together with the skin rash&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">As assessed by bone scintigraphy&#44; MRI&#44; or elevation of bone alkaline phosphatase&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Corresponds usually to the entity described as &#8220;neutrophilic urticarial dermatosis&#8221;&#59; absence of fibrinoid necrosis and significant dermal edema&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Neutrophils &#62;10&#44;000 mm<span class="elsevierStyleSup">3</span> and&#47;or CRP&#8239;&#62;&#8239;3&#8239;mg&#47;dL&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Strasbourg diagnostic criteria of Schnitzler syndrome&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autoimmune diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adult Onset Still Disease &#40;AOSD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Hematologic diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monoclonal gammopathy of undetermined significance &#40;MGUS&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>POEMS syndrome &#40;polyneuropathy&#44; organomegaly&#44; endocrinopathy&#44; mono-clonal gammopathy and skin changes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Waldenstr&#246;m macroglobulinemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple myeloma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Hereditary autoinflammatory syndromes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cryopyrin-associated syndromes &#40;CAPS&#41;&#58;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Familial cold urticaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muckle-Wells syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic infantile neurologic cutaneous and articular syndrome &#40;CINCA&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Infectious diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatitis B and C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic meningococcemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic Spontaneous Urticaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypocomplementemic urticarial vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Delayed pressure urticaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cryoglobulinemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beh&#231;et syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mastocytosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Differential diagnoses of Schnitzler syndrome&#46;</p>"
        ]
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Similarities and differences in autoinflammatory diseases with urticarial rash&#44; cryopyrin-associated periodic syndrome and Schnitzler syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Matsuda"
                            1 => "R&#46; Takimoto-Ito"
                            2 => "D&#46; Lipsker"
                            3 => "N&#46; Kambe"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.alit.2023.02.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergol Int&#46;"
                        "fecha" => "2023"
                        "volumen" => "72"
                        "paginaInicial" => "385"
                        "paginaFinal" => "393"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36906447"
                            "web" => "Medline"
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              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic recurrent wheals - if not chronic spontaneous urticaria&#44; what else&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Bonnekoh"
                            1 => "K&#46; Krause"
                            2 => "P&#46; Kolkhir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5414/ALX02375E"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergol Select&#46;"
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                        "volumen" => "7"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36644011"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammasomes and dermatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;C&#46; S&#225;"
                            1 => "Festa C&#46; Neto"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20165577"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2016"
                        "volumen" => "91"
                        "paginaInicial" => "566"
                        "paginaFinal" => "578"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27828627"
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                      "titulo" => "Schnitzler syndrome&#58; a review"
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                          "autores" => array:2 [
                            0 => "L&#46; Gusdorf"
                            1 => "D&#46; Lipsker"
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                    0 => array:2 [
                      "doi" => "10.1007/s11926-017-0673-5"
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                        "tituloSerie" => "Curr Rheumatol Rep&#46;"
                        "fecha" => "2017"
                        "volumen" => "19"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28718061"
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                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Aceituno Ca&#241;o"
                            1 => "E&#46;A&#46; Vogt S&#225;nchez"
                            2 => "L&#46; Le&#243;n Ruiz"
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ISSN: 03650596
Idioma original: Inglês
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