Ulcerative pyoderma gangrenosum associated with cocaine use

Estébanez, Andrea; Silva, Esmeralda; Abdilla, Noelia

doi:10.1016/j.medcle.2019.03.043

array:24 ["pii" => "S2387020620301212" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.03.043" "estado" => "S300" "fechaPublicacion" => "2020-05-08" "aid" => "4817" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:373-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S002577531930212X" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.03.009" "estado" => "S300" "fechaPublicacion" => "2020-05-08" "aid" => "4817" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:373-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Pioderma gangrenoso ulcerativo por consumo de cocaína" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "373" "paginaFinal" => "374" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ulcerative pyoderma gangrenosum associated with cocaine use" ] ] "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" => 1039 "Ancho" => 1250 "Tamanyo" => 223674 ] ] "descripcion" => array:1 [ "es" => "a) Lesión ulcerada de bordes sobreelevados, violáceos y fondo fibrinoide de 10cm de diámetro en región aquílea derecha; b) progresión de úlcera, francamente exudativa y con aparición de úlceras superficiales en vecindad pese a corticoterapia oral." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrea Estébanez, Esmeralda Silva, Noelia Abdilla" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Andrea" "apellidos" => "Estébanez" ] 1 => array:2 [ "nombre" => "Esmeralda" "apellidos" => "Silva" ] 2 => array:2 [ "nombre" => "Noelia" "apellidos" => "Abdilla" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620301212" "doi" => "10.1016/j.medcle.2019.03.043" "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/S2387020620301212?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531930212X?idApp=UINPBA00004N" "url" => "/00257753/0000015400000009/v1_202004270601/S002577531930212X/v1_202004270601/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620301236" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.03.045" "estado" => "S300" "fechaPublicacion" => "2020-05-08" "aid" => "4868" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:374-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the editor" "titulo" => "Answer to: “Asterixis as an atypical expression of hypercalcemia”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "374" "paginaFinal" => "375" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a: «Asterixis como forma de presentación atípica de hipercalcemia»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eugenia Ameneiros-Lago, Carmen Carballada-Rico, Francisco-José Fernández-Fernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Eugenia" "apellidos" => "Ameneiros-Lago" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Carballada-Rico" ] 2 => array:2 [ "nombre" => "Francisco-José" "apellidos" => "Fernández-Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319303148" "doi" => "10.1016/j.medcli.2019.03.035" "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/S0025775319303148?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620301236?idApp=UINPBA00004N" "url" => "/23870206/0000015400000009/v2_202005120646/S2387020620301236/v2_202005120646/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020620301194" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.12.024" "estado" => "S300" "fechaPublicacion" => "2020-05-08" "aid" => "4738" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;154:371-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Scleredema diabeticorum: Description of 11 cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "371" "paginaFinal" => "372" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Escleredema diabeticorum: descripción de 11 casos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 508 "Ancho" => 850 "Tamanyo" => 68168 ] ] "descripcion" => array:1 [ "en" => "Scleredema diabeticorum in one of our patients with type 1 diabetes mellitus." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Olga Simó-Guerrero, Assumpta Recasens-Gracia, Gabriel Giménez-Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Olga" "apellidos" => "Simó-Guerrero" ] 1 => array:2 [ "nombre" => "Assumpta" "apellidos" => "Recasens-Gracia" ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Giménez-Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319300053" "doi" => "10.1016/j.medcli.2018.12.008" "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/S0025775319300053?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620301194?idApp=UINPBA00004N" "url" => "/23870206/0000015400000009/v2_202005120646/S2387020620301194/v2_202005120646/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Ulcerative pyoderma gangrenosum associated with cocaine use" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "373" "paginaFinal" => "374" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andrea Estébanez, Esmeralda Silva, Noelia Abdilla" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Andrea" "apellidos" => "Estébanez" "email" => array:1 [ 0 => "andreaestebanez_7@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Esmeralda" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Noelia" "apellidos" => "Abdilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, Universidad de Valencia, 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" => "Pioderma gangrenoso ulcerativo por consumo de cocaína" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1039 "Ancho" => 1250 "Tamanyo" => 230398 ] ] "descripcion" => array:1 [ "en" => "(a) Ulcerative, raised margin, purple-coloured and fibrinoid fundus lesion of 10cm diameter in the right Achilles tendon; (b) ulcer progression, clearly exudative and with onset of surrounding surface ulcers despite oral corticosteroid therapy." ] ] ] "textoCompleto" => "Pyoderma gangrenosum (PG) is a rare ulcerative skin disease, considered a classic neutrophilic dermatosis. It is associated with systemic disease in 50–70% of cases, with inflammatory bowel disease (especially ulcerative colitis), haematological diseases (monoclonal gammopathies), infections and drugs being the most common. It has also been recently associated with cocaine use.<a class="elsevierStyleCrossRef" href="#bib0030">1</a>We report 3 cases of patients between 40 and 54 years of age with clinically and histologically PG-compatible lesions, secondary to cocaine use.Case 1: A 40-year-old woman with no history of interest was referred to dermatology for a 6-month history of intensely painful nodular lesions in the back, chin and retroauricular area.On physical examination, 3 deep, clear-margin, irregular and purple-coloured ulcerative lesions were observed on the right scapular area, left retroauricular region and chin.A biopsy was performed upon clinical suspicion of the infectious process, pyoderma gangrenosum or dermatitis artefacta. Histologically, necrosis was observed along with a dense neutrophilic inflammatory infiltrate with a fistulous tract. Cultures (bacteriological, mycological and mycobacteriological) were negative. Cocaine-positive urine toxins, negative serologies (HIV, hepatitis and syphilis), complete blood count with elevation of acute phase reactants (APR) and negative autoimmunity (ANA, ANCA and FR) were observed in the rest of the complementary tests.Treatment with prednisone 0.5mg/kg/day and local cures were started. A month later, the patient was admitted with constitutional symptoms that associated 39°C fever of unknown origin. A total body CT was performed in which, in addition to the destruction of the nasal septum and the lateral maxillary sinus wall, a left posterior perirenal and pararenal abscess of 8cm was observed. Given the size of the abscess, drainage was decided, obtaining sterile material, for which the diagnosis of sterile abscesses was established in the context of a neutrophilic dermatosis. After treatment with corticosteroids and cessation of cocaine use through a de-addiction programme, skin lesions and kidney abscess resolved.Case 2: a 51-year-old man, with a history of insulin-dependent diabetes mellitus who went to dermatology consultations for an ulcerative, intensely painful and rapidly progressive right Achilles tendon lesion. The examination showed an ulcerated purple-coloured lesion with raised margins, and a 10cm diameter fibrinoid fundus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>A biopsy was performed, showing a dense neutrophilic inflammatory infiltrate with peripheral vasculitis, findings consistent with suspicion of pyoderma gangrenosum. A complete blood test including serum total protein, autoimmunity and serologies was requested, highlighting a leukocytosis with deviation. Different pathogenic bacteria were isolated in the biopsy and exudate cultures, which were covered according to the antimicrobial susceptibility profile. The lesions continued to progress despite antibiotic therapy and 1mg/kg/day of prednisone, with the occurrence of other satellite-like lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Finally, the patient reported being a regular inhaled cocaine user, which was confirmed with the presence of toxins in the urine. The lesions only seemed to improve when consumption was temporarily interrupted, progressing to a complete involvement of the Achilles tendon and inhibiting the ability to walk.Case 3: a 54-year-old man with a history of insulin-dependent diabetes mellitus came to the dermatology emergency department for a 2-week history of painful skin lesions on the back, with no apparent trigger. On examination, 5 ulcerative lesions distributed over the entire back and left shoulder were observed, with raised erythematous, purple-coloured margins and a clear fundus, with sanguinopurulent exudate in some of them.A complete blood test with serologies, serum total protein test and autoimmunity was requested, highlighting a significant hyperglycaemia and ANA-positive (titre 1/320). Toxins in urine were positive for cocaine and benzodiazepines. A biopsy was performed with histological findings compatible with PG. Cultures were sterile.Oral corticosteroid therapy was started at 0.5mg/kg/day with glycaemic adjustment, as well as cures every 3 days. The patient has not used cocaine again, with repeatedly negative urine toxins, achieving significant improvement and partial healing of the lesions.PG is a relatively rare neutrophilic dermatosis with several possible clinical forms (ulcerative, blistering, pustular, vegetative,...). Most cases are associated with inflammatory bowel disease, arthritis, monoclonal gammopathy, or neoplasms. There are few reported cases of PG associated with cocaine use.<a class="elsevierStyleCrossRef" href="#bib0035">2</a>Cocaine can be detected in routine urinary toxicology tests up to 3 or 4 days after the last administration, although the highest diagnostic yield is obtained in the first 24 to 48h after consumption.Cutaneous manifestations associated with cocaine use are diverse. The most common clinical forms are leukocytoclastic vasculitis and cutaneous thrombotic vasculopathy, with PG being a possible, but rarely described, clinical form.<a class="elsevierStyleCrossRefs" href="#bib0030">1,3</a> A systemic involvement associated with a dermatological condition is rare, although they can develop arthralgias or even distant sterile neutrophilic infiltrates.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>Regarding serological findings, the most frequently found autoantibodies are antiphospholipid antibodies and ANCAs with a cytoplasmic (c-ANCA) or perinuclear (p-ANCA) fluorescence pattern.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> These findings are relevant, but they are not specific. Histologically, dermoepidermal necrosis and ulceration are observed with a dense inflammatory infiltrate, predominantly neutrophilic, in addition to varying degrees of vasculitis.Regarding treatment, the best documented efficacy is that of corticosteroids and cyclosporine, with both being first-line treatments.<a class="elsevierStyleCrossRefs" href="#bib0045">4,5</a> There are published cases of PG secondary to inhaled cocaine with an excellent response to infliximab,<a class="elsevierStyleCrossRef" href="#bib0040">3</a> however, in many cases, the condition of these patients make it difficult to initiate immunosuppressive treatments that require strict control. The best response, and even cure, will only be achieved in those cases in which cocaine use stops, regardless of the treatments used." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Estébanez A, Silva E, Abdilla N. Pioderma gangrenoso ulcerativo por consumo de cocaína. Med Clin (Barc). 2020;154:373–374." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1039 "Ancho" => 1250 "Tamanyo" => 230398 ] ] "descripcion" => array:1 [ "en" => "(a) Ulcerative, raised margin, purple-coloured and fibrinoid fundus lesion of 10cm diameter in the right Achilles tendon; (b) ulcer progression, clearly exudative and with onset of surrounding surface ulcers despite oral corticosteroid therapy." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestaciones cutáneas y mucosas asociadas al consumo de cocaína" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Imbernón" 1 => "R. Chico" 2 => "A. Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2016" "volumen" => "146" "paginaInicial" => "544" "paginaFinal" => "549" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levamisole-adulterated cocaine: what about in European countries?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Eiden" 1 => "C. Diot" 2 => "O. Mathieu" 3 => "M. Mallaret" 4 => "H. Peyrière" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/02791072.2014.959215" "Revista" => array:6 [ "tituloSerie" => "J Psychoactive Drugs" "fecha" => "2014" "volumen" => "46" "paginaInicial" => "389" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25364990" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Piodermas gangrenosos eruptivos asociados al consumo de cocaína inhalada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Roche" 1 => "T. Martínez-Menchón" 2 => "J.L. Sánchez-Carazo" 3 => "V. Oliver" 4 => "V. Alegre de Miquel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "727" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19087813" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pyoderma gangrenosum in refractory celiac disease: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Sedda" 1 => "R. Caruso" 2 => "I. Marafini" 3 => "Campione" 4 => "A. Orlandi" 5 => "F. Pallone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Gastroenterol" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "162" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Reichrath" 1 => "G. Bens" 2 => "A. Bonowitz" 3 => "W. Tilgen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2004.10.006" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "53" "paginaInicial" => "273" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16021123" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000009/v2_202005120646/S2387020620301212/v2_202005120646/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000009/v2_202005120646/S2387020620301212/v2_202005120646/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620301212?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 154. Issue 9.

Pages 373-374 (May 2020)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Free access articles

Associations of physical activity, sedentary time,...

Med Clin. 2024;163:327-35

Burden of COVID-19 variant omicron in immunocompromised...

Med Clin. 2024;163:347-59

Raynaud phenomenon in a baseball...

Med Clin. 2024;163:e79

Medicina Clínica (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter