Share
array:24 [ "pii" => "S2387020622001966" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.09.019" "estado" => "S300" "fechaPublicacion" => "2022-05-27" "aid" => "5840" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2022;158:493-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775321006394" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.09.027" "estado" => "S300" "fechaPublicacion" => "2022-05-27" "aid" => "5840" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2022;158:493-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Vasculitis cutánea tras vacunación frente a COVID-19" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "494" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cutaneous vasculitis due to COVID-19 vaccination" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 872 "Ancho" => 1500 "Tamanyo" => 322018 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Hallazgos histopatológicos en biopsia cutánea con tinción hematoxilina-eosina. B) Hallazgos histopatológicos en biopsia cutánea con PAS. <elsevierMultimedia ident="202205160511489121"></elsevierMultimedia>: depósito de material fibrinoide, microtrombos aislados y endotelios prominentes. <elsevierMultimedia ident="202205160511489122"></elsevierMultimedia>: infiltrado leucocitario con leucocitoclasia y extravasación hemática. C) Vasculitis leucocitoclástica. <span class="elsevierStyleBold">*</span> Lesiones cutáneas compatibles con púrpura palpable.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena María Gázquez Aguilera, Manuel Rodríguez García, María Teresa Cantón Yebra" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elena María" "apellidos" => "Gázquez Aguilera" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Rodríguez García" ] 2 => array:2 [ "nombre" => "María Teresa" "apellidos" => "Cantón Yebra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020622001966" "doi" => "10.1016/j.medcle.2021.09.019" "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/S2387020622001966?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006394?idApp=UINPBA00004N" "url" => "/00257753/0000015800000010/v1_202205160511/S0025775321006394/v1_202205160511/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020622001954" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.10.014" "estado" => "S300" "fechaPublicacion" => "2022-05-27" "aid" => "5831" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2022;158:494-5" "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">Scientific letter</span>" "titulo" => "Oropharyngeal persistence of SARS-CoV-2: Influence of viral load" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "494" "paginaFinal" => "495" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Persistencia orofaríngea de SARS-CoV-2: influencia de la carga viral" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuria Puente, Marina Fayos, Daniel Pablo-Marcos, Carmen Valero Díaz de Lamadrid" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Nuria" "apellidos" => "Puente" ] 1 => array:2 [ "nombre" => "Marina" "apellidos" => "Fayos" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Pablo-Marcos" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Valero Díaz de Lamadrid" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321006308" "doi" => "10.1016/j.medcli.2021.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006308?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622001954?idApp=UINPBA00004N" "url" => "/23870206/0000015800000010/v1_202206100851/S2387020622001954/v1_202206100851/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020622001991" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.12.003" "estado" => "S300" "fechaPublicacion" => "2022-05-27" "aid" => "5888" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2022;158:488-92" "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">Special article</span>" "titulo" => "Pay-for-performance schemes: 10 years’ experience in a comprehensive cancer center" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "488" "paginaFinal" => "492" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esquemas de pago basados en resultados de medicamentos: experiencia de 10 años en un centro monográfico de cancer" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Clopés Estela, Francesc Soler Rotllant, José Ramón Germà Lluch, Candela Calle Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Clopés Estela" ] 1 => array:2 [ "nombre" => "Francesc" "apellidos" => "Soler Rotllant" ] 2 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Germà Lluch" ] 3 => array:2 [ "nombre" => "Candela" "apellidos" => "Calle Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321007399" "doi" => "10.1016/j.medcli.2021.12.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321007399?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622001991?idApp=UINPBA00004N" "url" => "/23870206/0000015800000010/v1_202206100851/S2387020622001991/v1_202206100851/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Cutaneous vasculitis due to COVID-19 vaccination" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "494" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena María Gázquez Aguilera, Manuel Rodríguez García, María Teresa Cantón Yebra" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Elena María" "apellidos" => "Gázquez Aguilera" "email" => array:1 [ 0 => "elena.gaz.agui@gmail.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" => "Manuel" "apellidos" => "Rodríguez García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Teresa" "apellidos" => "Cantón Yebra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Torrecárdenas, Almería, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Torrecárdenas, Almería, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis cutánea tras vacunación frente a COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 872 "Ancho" => 1500 "Tamanyo" => 335419 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Histopathological findings in skin biopsy with haematoxylin-eosin staining. B) Histopathological findings in skin biopsy with PAS. <elsevierMultimedia ident="202206100852198401"></elsevierMultimedia>: deposition of fibrinoid material, isolated microthrombi and prominent endothelium. <elsevierMultimedia ident="202206100852198402"></elsevierMultimedia>: leukocytic infiltration with leukocytoclasis and blood extravasation. C) Allergic vasculitis. * Skin lesions compatible with palpable purpura.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronavirus disease-2019 was declared a pandemic in March 2020; since then, different strategies have been developed to control it. One of the main ones is vaccination,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with the description of side effects being relevant, given their novelty.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A wide variety of reactions have been documented following SARS-CoV-2 vaccination, especially with the use of the mRNA COVID-19 vaccines, Moderna and Pfizer. Local injection site reactions in the form of hives, measles-like rash, erythromelalgia, chilblain-like lesions and pityriasis rosea-<span class="elsevierStyleItalic">like</span> eruptions, as well as systemic reactions have been reported.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the clinical case of a 52-year-old male patient admitted on 4 April 2021 for an 8-day course of an erythematous, non-pruritic rash on both legs with petechiae up to the root of the lower limbs, which did not disappear on diascopy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The patient was vaccinated against SARS-CoV-2 with Moderna on 17th February and the second dose was administered on 17th March. The patient denied fever or other symptoms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests showed CRP 1.34 mg/dl, prothrombin time of 16.7 seconds, weak positive lupus anticoagulant with a ratio of 1.34 and D-dimer of 1908 ng/ml, negative direct Coombs test; autoimmunity, anti-beta-2-glycoprotein I and anti-cardiolipin antibodies, homocysteine, sedimentation rate, protein profile, immunoglobulins, 24 h urine and CBC within normal range.</p><p id="par0025" class="elsevierStylePara elsevierViewall">An assessment was requested by the dermatology department, whose clinical impression was allergic vasculitis on the thighs and both ankles, performing a skin biopsy for diagnostic confirmation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The anatomical pathology findings of the skin biopsy showed an epidermis with orthokeratin and no significant abnormalities. The superficial dermis showed signs of acute vascular damage, with a mild peripheral leukocyte infiltration, leukocytoclasis, blood extravasation, deposition of fibrinoid material, isolated microthrombi and prominent endothelium. No accompanying eosinophils were identified. It was associated with mild oedema of the papillary dermis, with no other findings, and without involvement of the deep dermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Thus, the initial diagnostic suspicion of allergic vasculitis was confirmed, and the lesions resolved with rest without the need for anti-inflammatory or steroid treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main skin reaction reported so far after administration of the Moderna vaccine was a local delayed skin reaction approximately 7 days after the first dose, in 94% of cases, with this percentage decreasing with the second dose, as well as the extent of the skin lesion. No cases of anaphylaxis or life-threatening cases were reported.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although most post-vaccination reactions are mild and limited to the site of inoculation, cases of vasculitis have been reported; in particular, allergic vasculitis following influenza vaccination in elderly patients<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and following pneumococcus, chickenpox and hepatitis A vaccination in an immunosuppressed patient.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the vaccines developed against the coronavirus, no cases of vasculitis have yet been described after administration, but hypersensitivity with cutaneous vasculitis developed after the above-mentioned vaccines reinforces the role of vaccination against SARS-CoV-2 as a trigger for vasculitis.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The case described was reported to pharmacovigilance because of its temporal relationship with the SARS-CoV-2 vaccination, as it occurred 11 days after the inoculation of the second dose of Moderna.</p><p id="par0060" class="elsevierStylePara elsevierViewall">SARS-CoV-2 vaccines can potentially precipitate cutaneous vasculitis, although well-designed and methodologically sound trials are needed to draw a definitive conclusion.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This research has not received any grants.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gázquez Aguilera EM, Rodríguez García M, Cantón Yebra MT. Vasculitis cutánea tras vacunación frente a COVID-19. Med Clin (Barc). 2022;158:493–494.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 872 "Ancho" => 1500 "Tamanyo" => 335419 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Histopathological findings in skin biopsy with haematoxylin-eosin staining. B) Histopathological findings in skin biopsy with PAS. <elsevierMultimedia ident="202206100852198401"></elsevierMultimedia>: deposition of fibrinoid material, isolated microthrombi and prominent endothelium. <elsevierMultimedia ident="202206100852198402"></elsevierMultimedia>: leukocytic infiltration with leukocytoclasis and blood extravasation. C) Allergic vasculitis. * Skin lesions compatible with palpable purpura.</p>" ] ] 1 => array:5 [ "identificador" => "202206100852198401" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 22 "Ancho" => 23 "Tamanyo" => 339 ] ] ] 2 => array:5 [ "identificador" => "202206100852198402" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 24 "Ancho" => 24 "Tamanyo" => 432 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SARS-CoV-2 vaccine candidates in rapid development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Li" 1 => "P. Guo" 2 => "X. Zhang" 3 => "Z. Yu" 4 => "W. Zhang" 5 => "H. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/21645515.2020.1804777" "Revista" => array:6 [ "tituloSerie" => "Hum Vaccin Immunother" "fecha" => "2021" "volumen" => "17" "paginaInicial" => "644" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33121319" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.E. McMahon" 1 => "E. Amerson" 2 => "M. Rosenbach" 3 => "J.B. Lipoff" 4 => "D. Moustafa" 5 => "A. Tyagi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2021.03.092" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2021" "volumen" => "85" "paginaInicial" => "46" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33838206" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed localized hypersensitivity reactions to the moderna COVID-19 vaccine: A case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.S. Johnston" 1 => "A. Galan" 2 => "K.L. Watsky" 3 => "A.J. Little" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2021.1214" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2021" "volumen" => "157" "paginaInicial" => "716" "paginaFinal" => "720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33978670" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leucocytoclastic vasculitis following influenza vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Cao" 1 => "D. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2016-217755" "Revista" => array:4 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2017" "volumen" => "2017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29146725" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukocytoclastic vasculitis after vaccination in a patient with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Fernández Prada" 1 => "P. Alonso Penanes" 2 => "P. Morales del Burgo" 3 => "I. Pérez Martinez" 4 => "M.C. Villa Del Amo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.17235/reed.2019.5963/2018" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2019" "volumen" => "111" "paginaInicial" => "402" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30859841" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000010/v1_202206100851/S2387020622001966/v1_202206100851/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000010/v1_202206100851/S2387020622001966/v1_202206100851/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622001966?idApp=UINPBA00004N" ]
