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array:23 [ "pii" => "S2387020624002869" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.11.040" "estado" => "S300" "fechaPublicacion" => "2024-07-26" "aid" => "6520" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2024;163:e15" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2387020624002857" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.11.039" "estado" => "S300" "fechaPublicacion" => "2024-07-26" "aid" => "6517" "copyright" => "Elsevier España, S.L.U." 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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;163:104-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Cycas revoluta</span> intoxication" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "105" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicación por <span class="elsevierStyleItalic">Cycas revoluta</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1975 "Ancho" => 2675 "Tamanyo" => 723066 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a: patient's place of work. b: remains brought from the patient to the emergency department. c: female <span class="elsevierStyleItalic">Cycas revoluta</span> detail (macrosporangia). d: red-brown seed or fruit with whitish inner pinnae.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Alonso Ecenarro, Francesc Puchades Gimeno, Benjamín Climent Díaz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Alonso Ecenarro" ] 1 => array:2 [ "nombre" => "Francesc" "apellidos" => "Puchades Gimeno" ] 2 => array:2 [ "nombre" => "Benjamín" "apellidos" => "Climent Díaz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775324001799" "doi" => "10.1016/j.medcli.2024.01.033" "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/S0025775324001799?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400278X?idApp=UINPBA00004N" "url" => "/23870206/0000016300000002/v1_202407220832/S238702062400278X/v1_202407220832/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>" "titulo" => "Salt-and-pepper appearance of the skin in systemic sclerosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e15" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Filiz Cemre Tasgöz, Emre Ali Acar, Mevlüt Kaçar, Özgül Soysal Gündüz, Sadettin Uslu" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Filiz Cemre" "apellidos" => "Tasgöz" ] 1 => array:2 [ "nombre" => "Emre" "apellidos" => "Ali Acar" ] 2 => array:2 [ "nombre" => "Mevlüt" "apellidos" => "Kaçar" ] 3 => array:2 [ "nombre" => "Özgül" "apellidos" => "Soysal Gündüz" ] 4 => array:4 [ "nombre" => "Sadettin" "apellidos" => "Uslu" "email" => array:1 [ 0 => "sadouslu@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aspecto sal y pimienta de la piel en la esclerosis sistémica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 1233 "Tamanyo" => 216256 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old female patient presented with a 6-month history of pruritus, thickening and discoloration of the skin, weight loss, weakness in upper and lower extremities and myalgia. She also reported Raynaud's phenomenon.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed salt-and-pepper pigmentation of the skin on bilateral hands, chest, back and forehead (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1A–D</a>). He also had sclerodactyly on examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). There was no telangiectasia, fingertip ulcers or perioral skin tightening. Muscle strength was 4/5 in both the upper and lower limbs. Laboratory tests revealed positive antinuclear antibodies (1:160 in the Hep2 cell line), normal serum creatine kinase levels, negative rheumatoid factor and anti-cyclic citrullinated peptide. Anti-PM/Scl antibody was positive. There were no significant findings on chest imaging, pulmonary function tests, electrocardiogram, and echography. Results of magnetic resonance imaging of the upper and lower extremities were consistent with myositis, but no electromyogram changes were detected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The diagnosis of diffuse cutaneous systemic sclerosis (SSc) was established, and treatment with prostacyclin, methylprednisolone and methotrexate was initiated.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinician should be cautious in the differential diagnosis as salt-and-pepper appearance may be mistaken for vitiligo or Addison's disease. The presence of salt-and-pepper appearance in association with cutaneous sclerosis provides strong evidence for a diagnosis of SSc.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from the patient.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author declared that this study has received no funding.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 1233 "Tamanyo" => 216256 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016300000002/v1_202407220832/S2387020624002869/v1_202407220832/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016300000002/v1_202407220832/S2387020624002869/v1_202407220832/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624002869?idApp=UINPBA00004N" ]
