Letter to the Editor
Erythematous-violaceous and bullous skin lesions after administration of iodinated contrast in a patient on hemodialysis. A case of fixed drug eruption due to iodinated contrast
Lesiones cutáneas eritematovioláceas y ampollosas tras administración de contraste yodado en un paciente en hemodiálisis. Un caso de exantema fijo medicamentoso por contraste yodado
Read
1913
Timeswas read the article
726
Total PDF
1187
Total HTML
Share statistics
array:24 [ "pii" => "S2013251423001384" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2021.05.009" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "964" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2023;43:508-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0211699521002009" "issn" => "02116995" "doi" => "10.1016/j.nefro.2021.05.008" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "964" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Nefrologia. 2023;43:508-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Lesiones cutáneas eritematovioláceas y ampollosas tras administración de contraste yodado en un paciente en hemodiálisis. Un caso de exantema fijo medicamentoso por contraste yodado" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "508" "paginaFinal" => "510" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Erythematous-violaceous and bullous skin lesions after administration of iodinated contrast in a patient on hemodialysis. A case of fixed drug eruption due to iodinated contrast" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 851 "Ancho" => 1255 "Tamanyo" => 110892 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desaparición de las lesiones a los 20 días de administrar contraste.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mara Lisbet Cabana Carcasi, Sara Rosalía Santana Romero, Laura Beato Coo, Maria Carmen Marcos Bravo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Mara Lisbet" "apellidos" => "Cabana Carcasi" ] 1 => array:2 [ "nombre" => "Sara Rosalía" "apellidos" => "Santana Romero" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Beato Coo" ] 3 => array:2 [ "nombre" => "Maria Carmen" "apellidos" => "Marcos Bravo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251423001384" "doi" => "10.1016/j.nefroe.2021.05.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251423001384?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521002009?idApp=UINPBA000064" "url" => "/02116995/0000004300000004/v3_202307241318/S0211699521002009/v3_202307241318/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2013251423001414" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2021.09.010" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "979" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2023;43:511-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "In response to the article “The challenge of cardiovascular disease in patients with chronic kidney disease”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "511" "paginaFinal" => "512" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "En respuesta al artículo «El reto de la enfermedad cardiovascular del paciente con enfermedad renal crónica»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan de Dios Arjona Barrionuevo, Luis Gil Sacaluga, Manuel Gonzales Vargas-Machuca, Francisco Guerrero Márquez, Ignacio Sainz Hidalgo, Manuel López Mendoza, Miguel Angel Gentil Govantes" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Juan de Dios" "apellidos" => "Arjona Barrionuevo" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Gil Sacaluga" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Gonzales Vargas-Machuca" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Guerrero Márquez" ] 4 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Sainz Hidalgo" ] 5 => array:2 [ "nombre" => "Manuel" "apellidos" => "López Mendoza" ] 6 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Gentil Govantes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699521002186" "doi" => "10.1016/j.nefro.2021.09.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521002186?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251423001414?idApp=UINPBA000064" "url" => "/20132514/0000004300000004/v2_202403080508/S2013251423001414/v2_202403080508/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2013251422001195" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2022.11.009" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "961" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2023;43:506-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Does food ingestion during hemodialysis lead to change in hepatic oxygenation?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "506" "paginaFinal" => "508" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La ingestión de alimentos durante la hemodiálisis, ¿produce cambios en la oxigenación hepática?" ] ] "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" => 2415 "Ancho" => 2500 "Tamanyo" => 210831 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Changes in %ΔBV during hemodialysis. (b) Changes in cerebral and hepatic rSO<span class="elsevierStyleInf">2</span> during hemodialysis. Grey arrow represents the decrease in hepatic rSO<span class="elsevierStyleInf">2</span> associated with food ingestion. (c) Changes in SBP, DBP and HR during hemodialysis. %ΔBV, relative change in blood volume; DBP, diastolic blood pressure; HR, heart rate; rSO<span class="elsevierStyleInf">2</span>, regional oxygen saturation; SBP, systolic blood pressure; UFR, ultrafiltration rate.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sojiro Imai, Kiyonori Ito, Susumu Ookawara, Satoshi Kiryu, Miho Iguchi, Hidenori Sanayama, Masafumi Kakei, Kaoru Tabei, Yoshiyuki Morishita" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Sojiro" "apellidos" => "Imai" ] 1 => array:2 [ "nombre" => "Kiyonori" "apellidos" => "Ito" ] 2 => array:2 [ "nombre" => "Susumu" "apellidos" => "Ookawara" ] 3 => array:2 [ "nombre" => "Satoshi" "apellidos" => "Kiryu" ] 4 => array:2 [ "nombre" => "Miho" "apellidos" => "Iguchi" ] 5 => array:2 [ "nombre" => "Hidenori" "apellidos" => "Sanayama" ] 6 => array:2 [ "nombre" => "Masafumi" "apellidos" => "Kakei" ] 7 => array:2 [ "nombre" => "Kaoru" "apellidos" => "Tabei" ] 8 => array:2 [ "nombre" => "Yoshiyuki" "apellidos" => "Morishita" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251422001195?idApp=UINPBA000064" "url" => "/20132514/0000004300000004/v2_202403080508/S2013251422001195/v2_202403080508/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Erythematous-violaceous and bullous skin lesions after administration of iodinated contrast in a patient on hemodialysis. A case of fixed drug eruption due to iodinated contrast" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "508" "paginaFinal" => "510" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mara Lisbet Cabana Carcasi, Sara Rosalía Santana Romero, Laura Beato Coo, Maria Carmen Marcos Bravo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Mara Lisbet" "apellidos" => "Cabana Carcasi" "email" => array:1 [ 0 => "mlcabana@friat.es" ] "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" => "Sara Rosalía" "apellidos" => "Santana Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Laura" "apellidos" => "Beato Coo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Maria Carmen" "apellidos" => "Marcos Bravo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de Hemodiálisis Os Carballos II, Fundación Renal Iñigo Álvarez de Toledo, Porriño, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Alergología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones cutáneas eritematovioláceas y ampollosas tras administración de contraste yodado en un paciente en hemodiálisis. Un caso de exantema fijo medicamentoso por contraste yodado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 851 "Ancho" => 1255 "Tamanyo" => 110430 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0450" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Disappearance of lesions 20 days after administering contrast.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-immediate hypersensitivity adverse reactions secondary to the use of iodinated contrast generally occur between 6 and 72<span class="elsevierStyleHsp" style=""></span>h after exposure,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with the most common manifestation being maculopapular rash, urticaria with or without angioedema and contact dermatitis. Most cases involve a mild to moderate acute rash. Severe late skin reactions are rare, but there have been reports of acute generalised exanthematous pustulosis, DRESS syndrome, vasculitis, Stevens–Johnson syndrome and toxic epidermal necrolysis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Fixed drug eruption (FDE) is another non-immediate hypersensitivity reaction that can be caused by iodinated contrast, but which has rarely been described in the literature.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">FDE is characterised by the appearance of one or several skin lesions in a fixed location, predominantly on the limbs, with a predilection for the hands, feet, lips, glans penis and perianal area. The lesions are erythematous-violaceous macules, of variable size from a few millimetres to 10–20<span class="elsevierStyleHsp" style=""></span>cm. They appear a few hours after the administration of a drug, forming oedematous plaques, which can sometimes develop vesicles and bullae containing blood-stained serous fluid, that, when broken, cause erosions, which are particularly painful in the genital and oral mucosa. Once the drug is withdrawn, the lesions evolve until they disappear within a couple of weeks, with subsequent reappearance in the same location after re-exposure to the drug, if that is the case. This is the pathognomonic characteristic of the condition.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is essentially clinical, based on the type of skin lesions, the history of drug administration and their resolution after discontinuation. Treatment consists of withdrawing the offending drug and symptomatic treatment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 77-year-old man with diabetic nephropathy and micronodular goitre, receiving regular treatment with acetylsalicylic acid, folic acid, omeprazole, insulin and atorvastatin. He had no history of drug or food allergies, atopy or other diseases. He had been on haemodialysis since 2013 through a left radiocephalic fistula, with multiple angioplasties for stenosis since 2014.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In July 2020, the patient had a repeat angioplasty due to dysfunction of his left radiocephalic fistula. The following day, a non-pruritic violaceous macular lesion was observed in the palm of his left hand, which looked like a bruise. Three days later, he developed pruritic violaceous macular lesions on the palms of both his hands and on the back of his fingers; a topical corticosteroid was prescribed. A week later, the violaceous macular lesions persisted on the palms of his hands and some had blistered. In addition, there was painful involvement of the palate and nostrils, with no other lesions on the rest of the skin or mucous membranes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He had not taken any other drugs.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After 12 days, the mucosal lesions had disappeared, but hyperpigmented areas persisted on the palms of his hands, which did eventually disappear at around 20 days (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">There is a description in the patient’s medical records of him developing pruritic macular lesions and some localised blisters on his hands, as well as scabs in his nostrils, after the last two angioplasties in 2018 and 2019. The lesions improved spontaneously within a few days, both types being mild in nature, for which no tests were carried out.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The images of the latest lesions were assessed by the Dermatology and Allergy Departments, with the latter performing an allergy study to a battery of iodinated contrasts (including the one involved: iodixanol) using intradermal skin tests with immediate and delayed readings (48 and 72<span class="elsevierStyleHsp" style=""></span>h), with negative results to the five contrast media tested. Epicutaneous testing with iodinated contrast in areas where skin lesions appeared could not be carried out because the locations made them difficult to perform. FDE induced by iodinated contrast was diagnosed based on compatible clinical data and an alternative contrast medium was indicated for the patient: iobitridol (with less potential for late-onset hypersensitivity).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Three months later, he required angioplasty once again due to dysfunction of the left radiocephalic fistula; the recommended contrast medium was used, without premedication, and the patient had no adverse skin reactions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnostic tests that can help diagnose FDE are skin biopsy and testing the suspected drug using skin patches on the affected skin area. However, given the absence of pathognomonic histopathology and the low sensitivity of patch tests (they can be positive in up to 30% of cases and are usually negative on healthy skin), it should be remembered that the diagnosis of FDE has to be based on the patient’s history and physical examination, assessing the morphology and fixed location of the skin lesions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In patients with suspected hypersensitivity reaction to iodinated contrast, allergic assessment with a complete medical history and an allergy study using a battery of iodinated contrast media are recommended. Based on these results, an alternative contrast can be indicated,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> as was the case with our patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 501 "Ancho" => 1750 "Tamanyo" => 111534 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0445" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lesions on the skin and mucous membranes after the administration of iodinated contrast.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 851 "Ancho" => 1255 "Tamanyo" => 110430 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0450" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Disappearance of lesions 20 days after administering contrast.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin testing in patients with hypersensitivity reactions to iodinated contrast media — a European multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Brockow" 1 => "A. Romano" 2 => "W. Aberer" 3 => "A.J. Bircher" 4 => "A. Barbaud" 5 => "P. Bonadonna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2008.01832.x" "Revista" => array:5 [ "tituloSerie" => "Allergy" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19178403" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immediate and delayed cutaneous reactions to radiocontrast media" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Brockow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000335631" "Revista" => array:6 [ "tituloSerie" => "Chem Immunol Allergy" "fecha" => "2012" "volumen" => "97" "paginaInicial" => "180" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22613862" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fixed drug eruption caused by iodinated contrast media" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Frias" 1 => "E. Fernandez" 2 => "M.T. Audicana" 3 => "N. Longo" 4 => "D. Muñoz" 5 => "S.M. Reyes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.2010.01816.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2011" "volumen" => "65" "paginaInicial" => "43" "paginaFinal" => "44" "itemHostRev" => array:3 [ "pii" => "S1043276017300164" "estado" => "S300" "issn" => "10432760" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exantema fijo medicamentoso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Avilés Izquierdo" 1 => "M. Huerta Brogeras" 2 => "R. Suárez Fernández" 3 => "P. Lázaro Ochaíta" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Integral" "fecha" => "2002" "volumen" => "40" "paginaInicial" => "251" "paginaFinal" => "255" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.elsevier.es/es-revista-medicina-integral-63-articulo-exantema-fijo-medicamentoso-13038548" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic evaluation of patients with noninmediate cutaneous hypersensitivity reactions to iodinated contrast media" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Torres" 1 => "F. Gomez" 2 => "I. Doña" 3 => "A. Rosendo" 4 => "C. Mayorga" 5 => "I. Garcia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2012.02840.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "929" "paginaFinal" => "935" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22583135" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for diagnosis and management of hypersensitivity reactions to contrast media" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Rosado Ingelmo" 1 => "I. Doña Diaz" 2 => "R. Cabañas Moreno" 3 => "M.C. Moya Quesada" 4 => "C. García-Avilés" 5 => "I. García Nuñez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18176/jiaci.0058" "Revista" => array:5 [ "tituloSerie" => "J Investig Allergol Clin Immunol" "fecha" => "2016" "volumen" => "26" "paginaInicial" => "144" "paginaFinal" => "155" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004300000004/v2_202403080508/S2013251423001384/v2_202403080508/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000004300000004/v2_202403080508/S2013251423001384/v2_202403080508/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251423001384?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 112 | 48 | 160 |
| 2024 September | 97 | 47 | 144 |
| 2024 August | 92 | 84 | 176 |
| 2024 July | 86 | 42 | 128 |
| 2024 June | 127 | 52 | 179 |
| 2024 May | 95 | 31 | 126 |
| 2024 April | 82 | 32 | 114 |
| 2024 March | 89 | 32 | 121 |
| 2024 February | 69 | 47 | 116 |
| 2024 January | 59 | 37 | 96 |
| 2023 December | 50 | 35 | 85 |
| 2023 November | 102 | 70 | 172 |
| 2023 October | 80 | 75 | 155 |
| 2023 September | 47 | 94 | 141 |
Show all
