LETTER TO THE EDITORS
LYME DISEASE LIKE SYNDROME ASSOCIATED LYMPHOCYTOMA: FIRST CASE REPORT IN BRAZIL
Natalino Yoshinari, Mariana Spolidorio, Virginia Lucia Bonoldi, Miriam Sotto
Department of Medicine – Rheumathology São Paulo University Medical School, São Paulo/SP, Brazil
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"autoresLista" => "Rafael Ferreira Coelho, Anuar Ibrahim Mitre, Miguel Srougi" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rafael Ferreira" "apellidos" => "Coelho" ] 1 => array:2 [ "nombre" => "Anuar Ibrahim" "apellidos" => "Mitre" ] 2 => array:2 [ "nombre" => "Miguel" "apellidos" => "Srougi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222030988?idApp=UINPBA00004N" "url" => "/18075932/0000006200000004/v1_202212060711/S1807593222030988/v1_202212060711/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222030964" "issn" => "18075932" "doi" => "10.1590/S1807-59322007000400019" "estado" => "S300" "fechaPublicacion" => "2007-08-01" "aid" => "3096" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "rev" "cita" => "Clinics. 2007;62:507-24" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => 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"nombre" => "Filomena" "apellidos" => "Galas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222030964?idApp=UINPBA00004N" "url" => "/18075932/0000006200000004/v1_202212060711/S1807593222030964/v1_202212060711/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">LETTER TO THE EDITORS</span>" "titulo" => "LYME DISEASE LIKE SYNDROME ASSOCIATED LYMPHOCYTOMA: FIRST CASE REPORT IN BRAZIL" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "525" "paginaFinal" => "526" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Natalino Yoshinari, Mariana Spolidorio, Virginia Lucia Bonoldi, Miriam Sotto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Natalino" "apellidos" => "Yoshinari" ] 1 => array:2 [ "nombre" => "Mariana" "apellidos" => "Spolidorio" ] 2 => array:2 [ "nombre" => "Virginia Lucia" "apellidos" => "Bonoldi" ] 3 => array:2 [ "nombre" => "Miriam" "apellidos" => "Sotto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Medicine – Rheumathology São Paulo University Medical School, São Paulo/SP, Brazil" "identificador" => "aff1" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 391 "Ancho" => 396 "Tamanyo" => 62132 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Dense inflammatory infiltrate composed by lymphocytes, histiocytes and rare eosinophils, around the skin blood vessels with a strong thickness of the walls. (250X).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The tick-borne disease found in Brazil, initially discovered in 1992, has been named Lyme Disease like syndrome (LDLS), because the clinical manifestations are similar with those observed in the Northern hemisphere, but the etiological agent was never isolated and polymerase chain reactions (PCR) with specific or broad recognizing primers of genera <span class="elsevierStyleItalic">Borrelia</span> were always negative in patients and ticks samples.<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1–9</span></a></p><p id="para20" class="elsevierStylePara elsevierViewall">Lymphocytoma cutis (LC) is considered as the stereotype example of the cutaneous B-cell pseudolymphoma. This lesion also designated as “Borrelia/Borrelial lymphocytoma”, represents the less common manifestation within the spectrum of <span class="elsevierStyleItalic">B. burgdorferi-</span>associated skin diseases.<a class="elsevierStyleCrossRefs" href="#bib10"><span class="elsevierStyleSup">10–13</span></a> We describe for the first time a clinical case of Borrelia lymphocytoma in Brazil.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE DESCRIPTION</span><p id="para30" class="elsevierStylePara elsevierViewall">VLBV, a 34 year old woman, lives in the city of Teresópolis, Rio de Janeiro. On January 2003, she came from a walk through Petrópolis, and noticed a tick on her left ankle. After 10 days, she perceived the appearance of vesicular lesions that started to rise, turning into blisters about 3 or 4 cm in diameter (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>). After almost three weeks, she developed important pain in the knees and hips, so that she looked for a rheumatologist, but all laboratorial results were negative.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">Due to the suspicion of Lyme disease, the patient's serum was sent to Pasteur Institute, Paris, France, where a strongly positive serology to <span class="elsevierStyleItalic">Borrelia burgdorferi</span> was detected. On February 2003, less than one month after the tick bite, the patient began treatment with doxycycline 100mg twice a day. A new sample of serum was delivered to the Laboratory of Rheumatology, of São Paulo University Medical School. The positive serology for <span class="elsevierStyleItalic">B. burgdorferi</span> was confirmed and she was guided to take ceftriaxone, for 20 days, maintaining the doxycycline for 90 days, because she was having a bad evolution, including episodes of cardiac arrhythmia.</p><p id="para50" class="elsevierStylePara elsevierViewall">Forty days after beginning with doxycycline, her condition improved, and it was decided that the residual blistered lesion should be dried up. Histopathological analysis revealed an epidermis with fragments of rectification of the interpapilar cones and hiperqueratosis. Subepidermis showed a crack or a gap without content. Dermis showed a moderated lymphocytic infiltrate either interstitial, perivascular, nodular or centralized. Occasionally, polimorphonuclear cells and plasma cells were observed.</p><p id="para60" class="elsevierStylePara elsevierViewall">A review of the slides was requested to a pathologist from Hospital das Clínicas, São Paulo University Medical School, who described epidermis with irregular acantosis and a mononuclear inflammatory infiltrate, consisted by lymphocytes, histiocytes and rare eosinophils (<a class="elsevierStyleCrossRefs" href="#fig2">Figures 2, 3, 4</a>).</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><p id="para70" class="elsevierStylePara elsevierViewall">More than 2 years after the beginning of the disease, the patient is having a good clinical follow up.</p><p id="para80" class="elsevierStylePara elsevierViewall">Conclusion: Cutaneous lymphoid hyperplasia, which can be a histological aspect of Lyme disease, can vary and includes the description above, but can have association with B-lymphoma.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para90" class="elsevierStylePara elsevierViewall">The patient described in the present manuscript presented typical epidemiological evidence, associated with skin lesions, arthritis and cardiac arrhythmia. Serological tests for <span class="elsevierStyleItalic">B. burgdorferi</span> antibodies confirmed diagnosis of LDLS. A western blotting (WB) assay perfomed in São Paulo revealed the presence of four bands for IgM class antibodies.</p><p id="para100" class="elsevierStylePara elsevierViewall">In a study done with 106 cases of lymphocytoma cutis associated to the infection by <span class="elsevierStyleItalic">B. burgdorferi,</span> histopathological analysis revealed the presence of an infiltrate constituted of small lymphocytes, histiocytes, eosinophils and plasma cells at the interpholicular regions. Out of these cases, 99.9% presented plasma cells and 84.2% presented eosinophils. As regards serology, performed with <span class="elsevierStyleItalic">B. burgdorferi,</span> 17% of the patients were IgM positive, 78.7% IgG positive and only 4.3% were negative.<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a></p><p id="para110" class="elsevierStylePara elsevierViewall">The distinction between primary cutaneous B-cell lymphoma and B-cell pseudolymphoma on a histological basis may be difficult, particularly in some cases of <span class="elsevierStyleItalic">B. burgdorferi</span>-associated lymphoid proliferations<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a>. Medical literature includes some cases where patients with pseudolymphoma progressed, after some years, to a malignant lymphoma and death.<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a></p><p id="para120" class="elsevierStylePara elsevierViewall">In a German study with children who presented lymphocytoma cutis and positive serology for Lyme disease, it was noticed that the ECM may precede the appearance of Borrelia lymphocytoma in the majority of the cases, but there are some reports of occurrence of both at the same time.<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a></p><p id="para130" class="elsevierStylePara elsevierViewall">When serial serology was done in our patient, the ELISA and WB patterns changed, as the disease got better. Serologic follow up is very important to confirm LDLS and also to predict clinical prognosis. This is the first report of Borrelia lymphocytoma in our country and it reinforces the existence of LDLS, a very important emerging tick-borne disease in Brazil, which reproduces most of symptoms observed in Lyme disease.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "CASE DESCRIPTION" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">Email: <span class="elsevierStyleInterRef" id="interrefs10" href="mailto:lyme@lim17.fm.usp.br">lyme@lim17.fm.usp.br</span></p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 542 "Ancho" => 449 "Tamanyo" => 31855 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Vesicular lesion with almost 3 or 4 cm and blister aspect.</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 392 "Ancho" => 383 "Tamanyo" => 32725 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Skin fragment demonstrating irregular acantosis on the epidermis. Mononuclear inflammatory infiltrate which follows the course of the skin blood vessels. (40X).</p>" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 391 "Ancho" => 396 "Tamanyo" => 62132 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Dense inflammatory infiltrate composed by lymphocytes, histiocytes and rare eosinophils, around the skin blood vessels with a strong thickness of the walls. (250X).</p>" ] ] 3 => array:7 [ "identificador" => "fig4" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 498 "Ancho" => 468 "Tamanyo" => 71209 ] ] "descripcion" => array:1 [ "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Detail of the inflammatory infiltrate around the skin blood vessels. (400X).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythema Chronicum Migrans and Lyme Arthritis: the enlarging clinical spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ AC Steere \n \t\t\t\t\t\t\t\t """ 1 => """ SE Malawista \n \t\t\t\t\t\t\t\t """ 2 => """ JA Hardin \n \t\t\t\t\t\t\t\t """ 3 => """ S Ruddy \n \t\t\t\t\t\t\t\t """ 4 => """ W Askenase \n \t\t\t\t\t\t\t\t """ 5 => """ WA Andiman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-86-6-685" "Revista" => array:6 [ "tituloSerie" => "Ann. Intern. Med." "fecha" => "1977" "volumen" => "86" "paginaInicial" => "685" "paginaFinal" => "698" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/869348" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revisão de borreliose de Lyme" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ AC Steere \n \t\t\t\t\t\t\t\t """ 2 => """ W Cossermelli \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Ass Med Brás." "fecha" => "1989" "volumen" => "35" "paginaInicial" => "34" "paginaFinal" => "38" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clínica e sorologia da doença de Lyme no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ PJL Barros \n \t\t\t\t\t\t\t\t """ 2 => """ FCM Cruz \n \t\t\t\t\t\t\t\t """ 3 => """ LK Oyafuso \n \t\t\t\t\t\t\t\t """ 4 => """ M Mendonça \n \t\t\t\t\t\t\t\t """ 5 => """ D Baggio \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rev Bras Reumatol." "fecha" => "1992" "volumen" => "4: 32" "paginaInicial" => "57" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Borreliose de Lyme" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ PJL Barros \n \t\t\t\t\t\t\t\t """ 2 => """ AH Fonseca \n \t\t\t\t\t\t\t\t """ 3 => """ VLN Bonoldi \n \t\t\t\t\t\t\t\t """ 4 => """ DM Barros-Batesti \n \t\t\t\t\t\t\t\t """ 5 => """ TTS Schumaker \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Zoonose emergente de interesse multidisciplinar, Newslab." "fecha" => "1995" "volumen" => "12" "paginaInicial" => "90" "paginaFinal" => "104" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perfil da borreliose de Lyme no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ PJL Barros \n \t\t\t\t\t\t\t\t """ 2 => """ VLN Bonoldi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Hosp Clin Fac Med S Paulo." "fecha" => "1997" "volumen" => "52" "paginaInicial" => "111" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9435406" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report of 57 cases of Lyme-like disease (LLD) in Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ PJL Barros \n \t\t\t\t\t\t\t\t """ 2 => """ G Gauditano \n \t\t\t\t\t\t\t\t """ 3 => """ AH Fonseca \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arthritis Rheum (Suppl)" "fecha" => "1999" "volumen" => "43" "paginaInicial" => "S188" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doença de Lyme-símile no Brasil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ 1 => """ VLN Bonoldi \n \t\t\t\t\t\t\t\t """ 2 => """ DM Barros-Battesti \n \t\t\t\t\t\t\t\t """ 3 => """ TTS Schumaker \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Bras Reumatol." "fecha" => "1999" "volumen" => "39" "numero" => "2" "paginaInicial" => "57" "paginaFinal" => "58" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perfil clínico e laboratorial da Doença de Lyme-símile no Estado de Mato Grosso do Sul: análise de 16 pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ IP Costa \n \t\t\t\t\t\t\t\t """ 1 => """ VLN Bonoldi \n \t\t\t\t\t\t\t\t """ 2 => """ NH Yoshinari \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Reumatol." "fecha" => "2001" "volumen" => "41" "paginaInicial" => "142" "paginaFinal" => "150" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Costa IP: Pesquisa de Anticorpos anti Borrelia e do Agente Etiológico, em soro e líquor de pacientes com manifestações clínicas compatíveis com a Doença de Lyme, no Estado de Mato Grosso do Sul, PhD Thesis, School of Medicine, São Paulo University. 1998; 125pp." ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Borrelia burgdorferi-associated lymphocytoma cútis: clinicopathotolic, immunophenotypic, and molecular study of 106 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ C Colli \n \t\t\t\t\t\t\t\t """ 1 => """ B Leinweber \n \t\t\t\t\t\t\t\t """ 2 => """ R Mullegger \n \t\t\t\t\t\t\t\t """ 3 => """ A Chott \n \t\t\t\t\t\t\t\t """ 4 => """ H Kerl \n \t\t\t\t\t\t\t\t """ 5 => """ L. Cerroni \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0303-6987.2003.00167.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol." "fecha" => "2004" "volumen" => "31" "paginaInicial" => "232" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14984575" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delineation of Borrelia burgdorferi sensu stricto, Borrelia garinii sp. Nov., and group VS461 associated with Lymeborreliosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ G Baranton \n \t\t\t\t\t\t\t\t """ 1 => """ D Postic \n \t\t\t\t\t\t\t\t """ 2 => """ I Saint Girons \n \t\t\t\t\t\t\t\t """ 3 => """ P Boerlin \n \t\t\t\t\t\t\t\t """ 4 => """ JC Piffaretti \n \t\t\t\t\t\t\t\t """ 5 => """ M Assous \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/00207713-42-3-378" "Revista" => array:6 [ "tituloSerie" => "Int J Syst Bacteriol." "fecha" => "1992" "volumen" => "42" "paginaInicial" => "378" "paginaFinal" => "383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1380285" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular subtyping of Borrelia burgdorferi sensu lato isolates from five patients with solitary lymphocytoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ RN Picken \n \t\t\t\t\t\t\t\t """ 1 => """ F Strle \n \t\t\t\t\t\t\t\t """ 2 => """ E Ruzic-Sabljic \n \t\t\t\t\t\t\t\t """ 3 => """ V Maraspin \n \t\t\t\t\t\t\t\t """ 4 => """ S Lotric-Furlan \n \t\t\t\t\t\t\t\t """ 5 => """ J Cimperman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jid.2021.12.031" "Revista" => array:7 [ "tituloSerie" => "J Invest Dermatol." "fecha" => "1997" "volumen" => "Jan; 108" "numero" => "1" "paginaInicial" => "92" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35109987" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Borrelia lymphocytoma in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ A Pohl-Koppe \n \t\t\t\t\t\t\t\t """ 1 => """ B Wilske \n \t\t\t\t\t\t\t\t """ 2 => """ M Weiss \n \t\t\t\t\t\t\t\t """ 3 => """ H. Schmidt \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006454-199805000-00017" "Revista" => array:7 [ "tituloSerie" => "Pediatr Infect Dis J." "fecha" => "1998" "volumen" => "17" "numero" => "5" "paginaInicial" => "423" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9613660" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "B-pseudolymphoma: lymphocytoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ AT Cortijo \n \t\t\t\t\t\t\t\t """ 1 => """ AO Medina \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Med Cutan Ibero Lat Am." "fecha" => "1986" "volumen" => "14" "numero" => "6" "paginaInicial" => "371" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3550311" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B-cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ F Grange \n \t\t\t\t\t\t\t\t """ 1 => """ J Wechsler \n \t\t\t\t\t\t\t\t """ 2 => """ JC Guillaume \n \t\t\t\t\t\t\t\t """ 3 => """ J Tortel \n \t\t\t\t\t\t\t\t """ 4 => """ MC Tortel \n \t\t\t\t\t\t\t\t """ 5 => """ B Audhuy \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2022.10.047" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2002" "volumen" => "Oct;47" "numero" => "4" "paginaInicial" => "530" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36404484" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006200000004/v1_202212060711/S1807593222030976/v1_202212060711/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006200000004/v1_202212060711/S1807593222030976/v1_202212060711/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222030976?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2024 October | 16 | 27 | 43 |
| 2024 September | 26 | 35 | 61 |
| 2024 August | 31 | 33 | 64 |
| 2024 July | 27 | 35 | 62 |
| 2024 June | 21 | 16 | 37 |
| 2024 May | 18 | 14 | 32 |
| 2024 April | 26 | 13 | 39 |
| 2024 March | 16 | 21 | 37 |
| 2024 February | 11 | 28 | 39 |
| 2024 January | 20 | 15 | 35 |
| 2023 December | 10 | 17 | 27 |
| 2023 November | 5 | 16 | 21 |
| 2023 October | 9 | 18 | 27 |
| 2023 September | 13 | 17 | 30 |
| 2023 August | 7 | 9 | 16 |
| 2023 July | 9 | 13 | 22 |
| 2023 June | 13 | 3 | 16 |
| 2023 May | 34 | 1 | 35 |
| 2023 April | 21 | 3 | 24 |
| 2023 March | 16 | 6 | 22 |
| 2023 February | 10 | 1 | 11 |
| 2023 January | 23 | 2 | 25 |
| 2022 December | 16 | 4 | 20 |
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