Diagnosis at first sight
Tonic pupil and dermal injuries, is it just what it seems?
Pupila tónica y lesiones dérmicas, ¿únicamente es lo que parece?
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "274" "paginaFinal" => "275" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María del Carmen Pecero-Hormigo, Cristina González-Tena, Elsa Gaspar-García, Leticia Nair López-Lara" "autores" => array:4 [ 0 => array:4 [ "nombre" => "María del Carmen" "apellidos" => "Pecero-Hormigo" "email" => array:1 [ 0 => "mamen_ph@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cristina" "apellidos" => "González-Tena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Elsa" "apellidos" => "Gaspar-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Leticia Nair" "apellidos" => "López-Lara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pupila tónica y lesiones dérmicas, ¿únicamente es lo que parece?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 174 "Ancho" => 900 "Tamanyo" => 30944 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anisocoria due to right pupil mydriatic and hyporeactive to light.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This case discusses a 33-year-old male who reported unprotected sex with men (MSM), consulting with a two-month history of night fever and non-painful, non-pruritic skin lesions and, in recent days, blurred vision in his right eye and intermittent headache. Physical examination revealed a widespread maculopapular rash, including on the palms of his hands and soles of his feet (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and marked anisocoria with right pupil mydriatic and hyporeactive to light and accommodation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), with no meningism or other focal neurological signs.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Tests showed the patient to be positive for anti-<span class="elsevierStyleItalic">T. pallidum</span> antibodies with an RPR titre of 1/128 and positive for anti-HIV antibodies (CD4 T-cell count 184 per mm<span class="elsevierStyleSup">3</span> and plasma viral load 110,012<span class="elsevierStyleHsp" style=""></span>copies/ml). Analysis of cerebrospinal fluid (CSF) showed 29 leucocytes/μl with predominance of lymphocytes (75%), glucose 51<span class="elsevierStyleHsp" style=""></span>mg/dl, proteins 0.84<span class="elsevierStyleHsp" style=""></span>g/dl and positive VDRL (venereal disease research laboratory test).</p><p id="par0015" class="elsevierStylePara elsevierViewall">With the diagnoses of HIV and neurosyphilis, the patient was given penicillin G sodium in continuous infusion for 14 days, antiretroviral treatment and primary prophylaxis for <span class="elsevierStyleItalic">P. jirovecii</span>. The patient made good progress, with the skin lesions disappearing and pupil contraction returning (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Nowadays, the tertiary forms of neurosyphilis (tabes dorsalis and progressive general paralysis) are rare, but early neurosyphilis is on the increase, especially in MSM with HIV infection.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a> Although the most common form of ocular neurosyphilis is uveitis, <span class="elsevierStyleItalic">T. pallidum</span> can affect almost any structure of the eye. The classic Argyll-Robertson pupil tends to accompany tertiary forms, while in our patient (with early syphilis) the mydriatic and non-reactive pupil (mimicking an Adie pupil) was the only manifestation of neurosyphilis; similar cases have even been described with no other signs of early syphilis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> It is therefore necessary to maintain a high degree of suspicion in the case of any eye disease in MSM, especially if they have HIV, and perform serology for syphilis and, if positive, a lumbar puncture to rule out neurosyphilis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pecero-Hormigo MC, González-Tena C, Gaspar-García E, López-Lara LN. Pupila tónica y lesiones dérmicas, ¿únicamente es lo que parece? Enferm Infecc Microbiol Clin. 2019;37:274–275.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 84226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maculopapular and erythematous exanthema on the trunk.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 174 "Ancho" => 900 "Tamanyo" => 30944 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anisocoria due to right pupil mydriatic and hyporeactive to light.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 263 "Ancho" => 900 "Tamanyo" => 33136 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recovery of right pupillary contraction after 10 days of treatment with penicillin G sodium.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sífilis e infección por el virus de la inmunodeficiencia humana: una endemia en hombres que tienen sexo con hombres" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.M. 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| 2020 May | 10 | 7 | 17 |
| 2020 April | 5 | 1 | 6 |
| 2020 March | 16 | 6 | 22 |
| 2020 February | 8 | 1 | 9 |
| 2020 January | 11 | 1 | 12 |
| 2019 December | 9 | 8 | 17 |
| 2019 November | 4 | 4 | 8 |
| 2019 October | 6 | 2 | 8 |
| 2019 April | 5 | 2 | 7 |
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