Case Report
Bronchiolitis Obliterans Associated With Paraneoplastic Pemphigus: a Paraneoplastic Autoimmune Multiorgan Syndrome
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Congregado, J. Loscertales, J.C. Girón-Arjona, R. Jim énez-Merchán, A. Arroyo-Tristán, R. González Cámpora" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Congregado" ] 1 => array:3 [ "preGrado" => "Prof., Dr" "nombre" => "J." "apellidos" => "Loscertales" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Girón-Arjona" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Jim énez-Merchán" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Arroyo-Tristán" ] 5 => array:2 [ "nombre" => "R." 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"apellidos" => "Iranzo" "email" => array:1 [ 0 => "piranzo@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Xaubet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Carrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Mascaró" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Campo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 5 => array:3 [ "nombre" => "C." "apellidos" => "Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínic, IDIBAPS, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Clínic, IDIBAPS, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínic, IDIBAPS, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dra. P. Iranzo. Servicio de Dermatología. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-09-08" "fechaAceptado" => "2003-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec153418" "palabras" => array:3 [ 0 => "Paraneoplastic pemphigus" 1 => "Paraneoplastic autoimmune multiorgan syndrome" 2 => "Bronchiolitis obliterans" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153417" "palabras" => array:3 [ 0 => "Pénfigo paraneoplásico" 1 => "Síndrome paraneoplásico autoinmune multiorgánico" 2 => "Bronquiolitis obliterante" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Paraneoplastic pemphigus is a mucocutaneous disease characterized by well defined clinical and immunopathological features associated with neoplasia. Recent evidence of bronchial epithelium involvement has led to the suggestion that this process is a paraneoplastic autoimmune multiorgan syndrome.</p> <span class="elsevierStyleSectionTitle">Clinical Observation</span><p class="elsevierStyleSimplePara elsevierViewall">We report the case of a patient with lichenoid eruptions on the skin and mucous membranes who later developed progressive dyspnea. With a suspected diagnosis of paraneoplastic autoimmune multiorgan syndrome, the following diagnostic tests were performed: histology and immunofluorescence of the skin, oral mucosa, and bronchial epithelium; indirect immunofluorescence of serum; pulmonary function tests; and evaluation for an occult neoplasm.</p><p class="elsevierStyleSimplePara elsevierViewall">Findings of pathology and immunofluorescence confirmed the suspected diagnosis. The computed thoracoabdominal tomography revealed signs of bronchiolitis and the presence of a retroperitoneal tumor.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Awareness of the mucocutaneous manifestations of paraneoplastic autoimmune multiorgan syndrome, and confirmation of this diagnosis by simple laboratory techniques can facilitate the early detection of occult neoplasia and forestall respiratory involvement.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">El pénfigo paraneoplásico es un cuadro cutaneomucoso con unas características clínicas e inmunopatológicas bien definidas, acompañado de una neoplasia. La evidencia de afectación del epitelio bronquial descrita posteriormente ha planteado considerarlo un síndrome paraneoplásico autoinmune multiorgánico.</p> <span class="elsevierStyleSectionTitle">Observación Clínica</span><p class="elsevierStyleSimplePara elsevierViewall">Se describe el caso de una paciente con una erupción liquenoide cutánea y mucosa, que posteriormente presentó disnea progresiva. Con la orientación diagnóstica de síndrome paraneoplásico autoinmune multiorgánico, se realizaron estudios de histología e inmunofluorescencia en piel, mucosa oral y epitelio bronquial, inmunofluorescencia indirecta con suero de la paciente, estudio del proceso respiratorio y búsqueda de neoplasia oculta.</p><p class="elsevierStyleSimplePara elsevierViewall">La anatomía patológica y los exámenes de inmunofluorescencia confirmaron la sospecha diagnóstica. La tomografía toracoabdominal reveló signos de bronquiolitis y la presencia de una tumoración retroperitoneal.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">El conocimiento de las manifestaciones mucocutáneas del síndrome paraneoplásico autoinmune multiorgánico y su confirmación por sencillas técnicas de la-boratorio pueden conducirnos a la detección temprana de la neoplasia oculta, evitando el desarrollo de la afección respiratoria.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic pemphigus: an autoimmune mucocutaneous disease associated with neoplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "GJ Anhalt" 1 => "SC Kim" 2 => "JR Stanley" 3 => "NJ Korman" 4 => "DA Jabs" 5 => "M Kory" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199012203232503" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1990" "volumen" => "323" "paginaInicial" => "1729" "paginaFinal" => "1735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2247105" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The mechanism of respiratory failure in paraneoplastic pemphigus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "HC Nousari" 1 => "R Deterding" 2 => "H Wojtczack" 3 => "S Aho" 4 => "J Uitto" 5 => "T Hashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl Med J" "fecha" => "1999" "volumen" => "340" "paginaInicial" => "1406" "paginaFinal" => "1410" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification, clinical manifestations and immunopathological mechanisms of the epithelial variant of paraneoplastic autoimmune multiorgan syndrome. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 2 | 3 |
| 2024 October | 35 | 21 | 56 |
| 2024 September | 31 | 19 | 50 |
| 2024 August | 43 | 32 | 75 |
| 2024 July | 26 | 33 | 59 |
| 2024 June | 33 | 20 | 53 |
| 2024 May | 26 | 27 | 53 |
| 2024 April | 16 | 21 | 37 |
| 2024 March | 22 | 14 | 36 |
| 2024 February | 19 | 21 | 40 |
| 2023 March | 1 | 3 | 4 |
| 2023 February | 14 | 19 | 33 |
| 2023 January | 21 | 27 | 48 |
| 2022 December | 14 | 21 | 35 |
| 2022 November | 13 | 18 | 31 |
| 2022 October | 18 | 21 | 39 |
| 2022 September | 15 | 19 | 34 |
| 2022 August | 46 | 42 | 88 |
| 2022 July | 42 | 23 | 65 |
| 2022 June | 19 | 30 | 49 |
| 2022 May | 12 | 24 | 36 |
| 2022 April | 14 | 30 | 44 |
| 2022 March | 13 | 34 | 47 |
| 2022 February | 22 | 21 | 43 |
| 2022 January | 11 | 27 | 38 |
| 2021 December | 19 | 44 | 63 |
| 2021 November | 13 | 40 | 53 |
| 2021 October | 23 | 43 | 66 |
| 2021 September | 18 | 42 | 60 |
| 2021 August | 11 | 23 | 34 |
| 2021 July | 12 | 30 | 42 |
| 2021 June | 11 | 25 | 36 |
| 2021 May | 15 | 24 | 39 |
| 2021 April | 49 | 61 | 110 |
| 2021 March | 15 | 24 | 39 |
| 2021 February | 14 | 16 | 30 |
| 2021 January | 8 | 16 | 24 |
| 2020 December | 9 | 12 | 21 |
| 2020 November | 4 | 10 | 14 |
| 2020 October | 7 | 13 | 20 |
| 2020 September | 7 | 5 | 12 |
| 2020 August | 10 | 13 | 23 |
| 2020 July | 6 | 14 | 20 |
| 2020 June | 3 | 3 | 6 |
| 2020 May | 11 | 16 | 27 |
| 2020 April | 15 | 11 | 26 |
| 2020 March | 13 | 7 | 20 |
| 2020 February | 46 | 18 | 64 |
| 2020 January | 12 | 15 | 27 |
| 2019 December | 17 | 11 | 28 |
| 2019 November | 8 | 9 | 17 |
| 2019 October | 9 | 10 | 19 |
| 2019 September | 7 | 11 | 18 |
| 2019 August | 14 | 6 | 20 |
| 2019 July | 12 | 18 | 30 |
| 2019 June | 19 | 7 | 26 |
| 2019 May | 14 | 10 | 24 |
| 2019 April | 8 | 45 | 53 |
| 2019 March | 9 | 25 | 34 |
| 2019 February | 7 | 12 | 19 |
| 2019 January | 3 | 10 | 13 |
| 2018 December | 7 | 10 | 17 |
| 2018 November | 14 | 13 | 27 |
| 2018 October | 26 | 27 | 53 |
| 2018 September | 9 | 11 | 20 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 6 | 4 | 10 |
| 2018 March | 1 | 1 | 2 |
| 2018 February | 3 | 8 | 11 |
| 2018 January | 2 | 4 | 6 |
| 2017 December | 7 | 14 | 21 |
| 2017 November | 4 | 19 | 23 |
| 2017 October | 8 | 18 | 26 |
| 2017 September | 5 | 15 | 20 |
| 2017 August | 7 | 16 | 23 |
| 2017 July | 5 | 17 | 22 |
| 2017 June | 8 | 23 | 31 |
| 2017 May | 3 | 28 | 31 |
| 2017 April | 6 | 22 | 28 |
| 2017 March | 3 | 22 | 25 |
| 2017 February | 2 | 9 | 11 |
| 2017 January | 2 | 16 | 18 |
| 2016 December | 4 | 18 | 22 |
| 2016 November | 12 | 15 | 27 |
| 2016 October | 17 | 14 | 31 |
| 2016 September | 6 | 18 | 24 |
| 2016 August | 5 | 4 | 9 |
| 2016 July | 4 | 12 | 16 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 63 | 1 | 64 |
| 2015 September | 47 | 17 | 64 |
| 2015 August | 65 | 10 | 75 |
| 2015 July | 54 | 5 | 59 |
| 2015 June | 41 | 12 | 53 |
| 2015 May | 54 | 6 | 60 |
| 2015 April | 51 | 11 | 62 |
| 2015 March | 57 | 8 | 65 |
| 2015 February | 53 | 10 | 63 |
| 2015 January | 51 | 5 | 56 |
| 2014 December | 41 | 9 | 50 |
| 2014 November | 61 | 12 | 73 |
| 2014 October | 70 | 10 | 80 |
| 2014 September | 49 | 11 | 60 |
| 2014 August | 49 | 10 | 59 |
| 2014 July | 49 | 5 | 54 |
| 2014 June | 68 | 12 | 80 |
| 2014 May | 76 | 7 | 83 |
| 2014 April | 63 | 3 | 66 |
| 2014 March | 110 | 13 | 123 |
| 2014 February | 69 | 8 | 77 |
| 2014 January | 64 | 8 | 72 |
| 2013 December | 51 | 14 | 65 |
| 2013 November | 49 | 5 | 54 |
| 2013 October | 43 | 7 | 50 |
| 2013 September | 66 | 10 | 76 |
| 2013 August | 50 | 7 | 57 |
| 2013 July | 45 | 17 | 62 |
| 2013 June | 54 | 8 | 62 |
| 2013 May | 38 | 9 | 47 |
| 2013 April | 23 | 6 | 29 |
| 2013 March | 7 | 1 | 8 |
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