Medicine in Images
Antiphospholipid syndrome: The importance of skin manifestations
Síndrome antifosfolípido: la importancia de las manifestaciones cutáneas
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Algado, P. Oteo López, A.M. Garijo Sáiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.T." "apellidos" => "Algado" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Oteo López" ] 2 => array:2 [ "nombre" => "A.M." "apellidos" => "Garijo Sáiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300979?idApp=WRCEE" "url" => "/22548874/0000022000000004/v1_202004301501/S2254887419300979/v1_202004301501/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in Images</span>" "titulo" => "Antiphospholipid syndrome: The importance of skin manifestations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "266" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Matellanes Palacios, E. Quecedo Estébanez, S. Añon Roig" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Matellanes Palacios" "email" => array:1 [ 0 => "mariamatellanes@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Quecedo Estébanez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Añon Roig" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Arnau de Vilanova, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome antifosfolípido: la importancia de las manifestaciones cutáneas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1162 "Ancho" => 1740 "Tamanyo" => 262330 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 49-year old woman with no medical history was admitted for a hysterectomy due to fibroids. Necrotic purpuric lesions were observed in the fifth toe of the right foot (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and livedo racemosa/livedo reticularis lesions on the thighs, hands and feet (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). These lesions caused paresthesia and coldness, with preserved pulses. The patient complained of tremors, loss of strength in the right hand and headaches in the past year.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We performed 2 skin biopsies of the left thigh, which showed minimal perivascular lymphocytic infiltrates in the superficial dermis, with no thrombi in the vascular lumens (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The laboratory study showed triple positivity at high titers of antiphospholipid antibodies: anticardiolipin antibodies, anti-beta-2-glycoprotein 1 and lupus anticoagulant, which was subsequently confirmed in a second reading, with negative antinuclear antibodies. We also performed a transthoracic and transesophageal echocardiogram, which showed images suggestive of thrombotic endocarditis in the mitral valve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). In the brain angio-magnetic resonance, we observed brain lesions suggestive of previous embolisms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). With these findings, we established the diagnosis of antiphospholipid syndrome and started treatment with anticoagulation and antiplatelet agents, which showed good progress.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Antiphospholipid syndrome or Hughes syndrome is a systemic autoimmune disease characterized by arterial thromboembolic, venous and microcirculation events and morbidity during pregnancy in the presence of persistent antiphospholipid antibodies. The clinical manifestations are varied, with the skin type being very common. Up to 50% of such patients present skin manifestations, which can be the first or only symptom. A correlation has been observed between the presence of <span class="elsevierStyleItalic">livedo reticularis</span> and arterial thrombosis, cardiac abnormalities and central nervous system disorders.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-01-01" "fechaAceptado" => "2019-01-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Matellanes Palacios M, Quecedo Estébanez E, Añon Roig S. Síndrome antifosfolípido: la importancia de las manifestaciones cutáneas. Rev Clin Esp. 2020;220:265–266.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1162 "Ancho" => 1740 "Tamanyo" => 262330 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000004/v1_202004301501/S2254887419301006/v1_202004301501/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000004/v1_202004301501/S2254887419301006/v1_202004301501/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301006?idApp=WRCEE" ]
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