metricas
covid
Buscar en
Archivos de la Sociedad Española de Oftalmología (English Edition)
Toda la web
Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab ...
Journal Information

Statistics

Follow this link to access the full text of the article

Short communication
Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment
Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab
V.M. Asensio-Sánchez
Corresponding author
victor_asensio@orangemail.es

Corresponding author.
, L. Díaz-Cabanas, A. Martín-Prieto, B. Haro-Álvarez
Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain
Read
1
Times
was read the article
1
Total PDF
0
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173579417302074"
  "issn" => "21735794"
  "doi" => "10.1016/j.oftale.2017.11.008"
  "estado" => "S300"
  "fechaPublicacion" => "2018-03-01"
  "aid" => "1213"
  "copyright" => "Sociedad Española de Oftalmología"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Arch Soc Esp Oftalmol. 2018;93:147-50"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0365669117302046"
      "issn" => "03656691"
      "doi" => "10.1016/j.oftal.2017.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2018-03-01"
      "aid" => "1213"
      "copyright" => "Sociedad Española de Oftalmología"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Arch Soc Esp Oftalmol. 2018;93:147-50"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1031
        "formatos" => array:2 [
          "HTML" => 22
          "PDF" => 1009
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Comunicaci&#243;n corta</span>"
        "titulo" => "Tub&#233;rculo coroideo asintom&#225;tico en un paciente con enfermedad de Crohn en tratamiento con adalimumab"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "147"
            "paginaFinal" => "150"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Asymptomatic choroidal tubercle in a patient with Crohn&#39;s disease on adalimumab treatment"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "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" => 2958
                "Ancho" => 2833
                "Tamanyo" => 871654
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A&#46; Retinograf&#237;a normal del ojo derecho&#46; B&#46; Retinograf&#237;a del ojo izquierdo&#58; tub&#233;rculo coroideo que se presenta como un n&#243;dulo solitario&#44; blanco-amarillento&#44; de bordes irregulares&#44; subretiniano&#44; no asociado con desprendimiento seroso de retina&#46; Sugiere diseminaci&#243;n hemat&#243;gena de la tuberculosis&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">C&#46; Fase arteriovenosa tard&#237;a de la angiograf&#237;a fluoresce&#237;nica del ojo izquierdo mostrando aumento de la fluorescencia en tiempos tard&#237;os&#46; D&#46; SD-OCT&#58; no se observa elevaci&#243;n de la retina neurosensorial ni asociaci&#243;n con desprendimiento seroso de retina&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46;M&#46; Asensio-S&#225;nchez, L&#46; D&#237;az-Cabanas, A&#46; Mart&#237;n-Prieto, B&#46; Haro-&#193;lvarez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "V&#46;M&#46;"
                "apellidos" => "Asensio-S&#225;nchez"
              ]
              1 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "D&#237;az-Cabanas"
              ]
              2 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mart&#237;n-Prieto"
              ]
              3 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Haro-&#193;lvarez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173579417302074"
          "doi" => "10.1016/j.oftale.2017.11.008"
          "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/S2173579417302074?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117302046?idApp=UINPBA00004N"
      "url" => "/03656691/0000009300000003/v1_201802240423/S0365669117302046/v1_201802240423/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173579417302098"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2017.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2018-03-01"
    "aid" => "1189"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2018;93:151-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>"
      "titulo" => "Peripapillar retinal hamartoma associated with tuberous sclerosis&#46; Case report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "151"
          "paginaFinal" => "154"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A prop&#243;sito de un caso de hamartoma retiniano adyacente a cabeza de nervio &#243;ptico en un caso de esclerosis tuberosa"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2270
              "Ancho" => 2667
              "Tamanyo" => 642496
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">OCT showing subretinal fluid exudation from the papilla to the fovea&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Hern&#225;ndez Pardines, S&#46; N&#250;&#241;ez M&#225;rquez, L&#46; Fern&#225;ndez Montalvo, M&#46;C&#46; Serra Verd&#250;, A&#46; Ju&#225;rez Marroqu&#237;"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Hern&#225;ndez Pardines"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "N&#250;&#241;ez M&#225;rquez"
            ]
            2 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Fern&#225;ndez Montalvo"
            ]
            3 => array:2 [
              "nombre" => "M&#46;C&#46;"
              "apellidos" => "Serra Verd&#250;"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Ju&#225;rez Marroqu&#237;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0365669117301302"
        "doi" => "10.1016/j.oftal.2017.03.010"
        "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/S0365669117301302?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417302098?idApp=UINPBA00004N"
    "url" => "/21735794/0000009300000003/v1_201803010437/S2173579417302098/v1_201803010437/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173579417302050"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2017.11.006"
    "estado" => "S300"
    "fechaPublicacion" => "2018-03-01"
    "aid" => "1218"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2018;93:143-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>"
      "titulo" => "Retinal toxicity after accidental intravitreal injection of mepivacaine and adrenaline"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "143"
          "paginaFinal" => "146"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Afectaci&#243;n retiniana tras inyecci&#243;n accidental intrav&#237;trea de mepivaca&#237;na y epinefrina"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1003
              "Ancho" => 990
              "Tamanyo" => 101077
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Photographic composition showing the subretinal anesthetic injection area&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; L&#243;pez-Herrero, J&#46;L&#46; S&#225;nchez-Vicente, J&#46; Monge-Esquivel, E&#46; Parra-Oviedo, A&#46; Mart&#237;nez-Borrego, A&#46; Mu&#241;oz-Morales"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "L&#243;pez-Herrero"
            ]
            1 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "S&#225;nchez-Vicente"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Monge-Esquivel"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Parra-Oviedo"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mart&#237;nez-Borrego"
            ]
            5 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mu&#241;oz-Morales"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0365669117302095"
        "doi" => "10.1016/j.oftal.2017.06.014"
        "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/S0365669117302095?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417302050?idApp=UINPBA00004N"
    "url" => "/21735794/0000009300000003/v1_201803010437/S2173579417302050/v1_201803010437/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>"
    "titulo" => "Asymptomatic choroidal tubercle in a patient with Crohn&#39;s disease on adalimumab treatment"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "147"
        "paginaFinal" => "150"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46;M&#46; Asensio-S&#225;nchez, L&#46; D&#237;az-Cabanas, A&#46; Mart&#237;n-Prieto, B&#46; Haro-&#193;lvarez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "V&#46;M&#46;"
            "apellidos" => "Asensio-S&#225;nchez"
            "email" => array:1 [
              0 => "victor&#95;asensio&#64;orangemail&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "L&#46;"
            "apellidos" => "D&#237;az-Cabanas"
          ]
          2 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Mart&#237;n-Prieto"
          ]
          3 => array:2 [
            "nombre" => "B&#46;"
            "apellidos" => "Haro-&#193;lvarez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Hospital Cl&#237;nico Universitario&#44; Valladolid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tub&#233;rculo coroideo asintom&#225;tico en un paciente con enfermedad de Crohn en tratamiento con adalimumab"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 752
            "Ancho" => 950
            "Tamanyo" => 69798
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Marginal retraction and depigmentation of the choroidal tuber after 6 months of antituberculostatic treatment&#46; The lesion shows improved edges&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Crohn&#39;s disease &#40;CD&#41; is an intestinal inflammatory disease that could have uncertain and severe prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> Biological therapy is a first-line treatment to induce remission in the severest forms of CD&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> Adalimumab is an anti-tumor necrosis factor &#945; &#40;TNF-&#945;&#41; monoclonal antibody which&#44; by diminishing the effect of the immune system&#44; increases the risk of infections such as tuberculosis &#40;TB&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> Despite the increased incidence of TB&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> choroidal tubers are rare and generally asymptomatic&#44; except in immunodepressed patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The present article describes an unusual case with very few reports of an asymptomatic choroidal tuber in the context of a miliary pulmonary TB in a patient with severe CD treated with adalimumab&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male&#44; 48&#44; with severe ileocecal CD treated with Humira<span class="elsevierStyleSup">&#174;</span> &#40;adalimumab&#44; AbbVie Bioresearch Center&#46; 100 Research Drive&#46; Worcester&#44; MA 01605&#44; USA&#41;&#44; 40<span class="elsevierStyleHsp" style=""></span>mg subcutaneous every 2 weeks with prior screening for biologic medicaments according to standard practice &#40;chest X-ray&#44; serology for hepatitis B and C virus&#44; herpes simplex virus&#44; herpes zoster virus&#44; cytomegalovirus&#44; HIV and Mantoux&#41;&#46; During the month of treatment the patient was admitted due to asthenia&#44; loss of appetite and fever of up to 39<span class="elsevierStyleHsp" style=""></span>&#176;C with one week evolution&#44; predominantly during the evening&#46; A study for fever of unknown cause was requested consisting in Mantoux&#44; urine and blood culture&#44; chest X-ray&#44; viral serology&#44; Brucella and blood culture for mycobacteria as well as echocardiogram for discarding endocarditis&#46; It was considered that the patient had high risk of contracting TBC&#44; and therefore of Quantiferon-TB test and Mantoux were taken&#46; The first test was positive and the second test 48<span class="elsevierStyleHsp" style=""></span>hours later revealed a erythema and at 72<span class="elsevierStyleHsp" style=""></span>hours a 10<span class="elsevierStyleHsp" style=""></span>mm induration&#46; Chest X-ray showed bilateral micronodular pattern&#44; particularly at the hilar and paratracheal level&#44; all of which indicated disseminated miliary TB &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Anti-TNF-&#945; treatment was withdrawn&#44; introducing azathioprine 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#46; Anti-tuberculosis shock treatment was initiated with isoniazide 300<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; rifampicin 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; pyrazinamide 40<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day and streptomycin 15<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day during 4 months&#44; followed by isoniazide and rifampicin for 12 additional months&#46; One week after admission&#44; following the protocol of the infectious diseases department&#44; ophthalmological examination was carried out producing a visual acuity of 1 in both eyes and absence of anterior segment inflammation&#46; In addition&#44; right eye fundus was normal &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#44; while the left eye fundus revealed a mass having 2&#47;3 disk diameter&#44; temporal-superior location vis-&#224;-vis the optic disk&#44; whitish yellow color and slightly uneven but well defined contour &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; No inflammation&#44; exudation&#44; hemorrhage or associated retinal detachment were observed&#46; Fluorescein angiography revealed slight early fluorescence with moderate-intense late hyperfluorescence &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; Optical coherence tomography did not show elevation of the mass or association with serous retinal detachment&#46; The choroids could not be seen in the image because it did not appear complete due to poor patient cooperation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46; Differential diagnostic included syphilis&#44; toxoplasmosis&#44; sarcoidosis&#44; brucellosis&#44; choroidal hemangioma&#44; metastasis and amelanotic melanoma&#46; Angiotensin-converting enzyme levels were normal&#46; Similarly&#44; serological studies for HIV&#44; syphilis&#44; toxoplasma and brucellosis were negative&#46; Ocular echography did not show alterations&#46; After 6 months a slow but significant reduction of the choroidal tuber size was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the 19th century TB was one of the most severe infectious diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In 2013&#44; 9 million people contracted the disease and 1&#46;5 million died due to TB throughout the world&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Paradoxically&#44; increased incidence in Western countries is due to improved social and health conditions and longer life expectancy as well as the increase of tumors&#44; increased amount of transplants&#44; therapies such as biological therapy that has increased its indications and the globalized immigration of malnourished populations&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The immune system is essential to control tuberculosis infection&#44; wherein TNF-&#945; plays a crucial role&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Anti-TNF-&#945; are utilized as first-line therapy in patients with complicated CD&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> Adalimumab is an anti-TNF-&#945; monoclonal antibody which&#44; in contrast with other biologic agents&#44; is administered subcutaneously&#44; thus involving obvious advantages for the patient and hospital structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; adverse effects related with this therapy such as reactions against infusion&#44; demyelinization disease&#44; self-immune reactions and infections such as tuberculosis<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> should always be taken into account&#46; Intraocular tuberculosis could be the result of direct infection&#44; hematogenous dissemination&#44; or could be induced by immune hypersensitivity response type IV which could compromise any ocular structure&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Most common clinic presentation is posterior uveitis&#44; particularly choroidal tuberculosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> It has been described that multiple choroidal tubers are the most common intraocular expression of tuberculose posterior uveitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> However&#44; it is rare to find a tuber in the choroids except in patients infected by the human immunodeficiency virus&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Tubers present as uni-or bilateral yellowish white lesions with poorly defined edges&#44; solitary or in small groups located deeply within the choroids and posterior pole<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a> and are generally associated with vitreous inflammation and subretinal fluid&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a> However&#44; in immunodepressed patients &#40;HIV&#44; biological therapy&#41;&#44; choroidal tubers could be typically nonreactive&#44; with absence or slight vitreous inflammation and&#44; due to their deep location in the choroids&#44; could go unnoticed as in the case described herein&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The present patient did not exhibit specific signs in OCT although an adequate OCT image could not be obtained due to the fatigue shown by the patient&#46; OCT could be useful to differentiate choroidal tuberculose granulomas from non-inflammatory diseases with similar clinic appearance&#46; An OCT section over the granuloma shows a distinctive sign&#44; i&#46;e&#46;&#44; the link between the choriocapillary-pigment epithelium layer and the neurosensory retina &#40;contact sign&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> This sign is associated with the presence of surrounding subretinal fluid and inflammatory infiltrates in the deep retina&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;9</span></a> The contact sign and subretinal fluid were not observed in the present case&#44; where the choroidal tuberculosis diagnostic was established by means of Quantiferon-TB and positive Mantoux&#46; Chest X-ray confirmed systemic tuberculosis while laboratory and imaging tests excluded other etiologies&#46; The tuber size diminished considerably with specific treatment&#44; without exhibiting inflammation or exudation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">TB screening should be very exhaustive&#44; including epidemiological antecedents and finding out if any previous vaccine was received&#44; as well as assessing changes in the sociological environment of the patient&#46; In a review and meta-analysis&#44; Zhang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> indicated that the risk of tuberculosis could increase significantly in patients treated with TNF-&#945;&#44; antagonists&#44; particularly if they have rheumatoid arthritis&#46; When TB is diagnosed&#44; the therapeutic approach is to withdraw biologic therapies and initiate anti-TB treatment&#46; It does not seem necessary to withdraw corticoids or immunomodulators&#46; Anti-TNF-&#945; should not be resumed in patients with active infection before 2 months since the anti-TB treatment&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the re-emergence of tuberculosis and the increased indications for biological therapy&#44; ophthalmologists should be aware that a solitary choroidal tuber could be diagnosed in ophthalmologically asymptomatic patients and that many do not report said treatments&#44; making exhaustive clinic history essential&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres993669"
          "titulo" => "Abstract"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Case report"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Discussion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec957106"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres993668"
          "titulo" => "Resumen"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Caso cl&#237;nico"
            ]
            2 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Discusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec957105"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinic case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflict of interests"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-03-25"
    "fechaAceptado" => "2017-06-21"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec957106"
          "palabras" => array:5 [
            0 => "Adalimumab"
            1 => "Biological therapy"
            2 => "Miliary tuberculosis"
            3 => "Choroidal tubercle"
            4 => "Crohn&#39;s disease"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec957105"
          "palabras" => array:5 [
            0 => "Adalimumab"
            1 => "Terapia biol&#243;gica"
            2 => "Tuberculosis miliar"
            3 => "Tub&#233;rculo coroideo"
            4 => "Enfermedad de Crohn"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Adalimumab&#44; an anti-tumor necrosis factor alpha therapy for active Crohn&#39;s disease &#40;CD&#41;&#44; is associated with increased risks of tuberculosis infection&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The case is presented of a 48 year-old male with active CD on treatment with adalimumab&#46; After three months&#44; he developed a miliary pulmonary tuberculosis infection&#44; with a solitary non-reactive choroidal tubercle temporal-superior to the optic disk being found in an ophthalmological study&#46; Fluorescein angiography showed late hyperfluorescence in a staining pattern&#46; Optic coherence tomography showed a flat mass without serous retinal detachment&#46; The choroidal tubercle slowly regressed with antituberculosis therapy&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab&#46;</p></span>"
        "secciones" => array:3 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Case report"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Discussion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducci&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adalimumab&#44; un antifactor de necrosis tumoral que se utiliza en la enfermedad de Crohn activa &#40;EC&#41;&#44; se asocia con un mayor riesgo de tuberculosis&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso cl&#237;nico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se describe el caso de un var&#243;n de 48 a&#241;os con EC activa en tratamiento con adalimumab&#46; Despu&#233;s de 3 meses desarroll&#243; una tuberculosis pulmonar miliar&#44; y en un estudio oftalmol&#243;gico se encontr&#243; un tub&#233;rculo coroideo no reactivo solitario temporal superior al disco &#243;ptico&#46; La angiofluoresceingraf&#237;a mostr&#243; hiperfluorescencia tard&#237;a&#46; Con la tomograf&#237;a de coherencia &#243;ptica se observ&#243; una masa plana sin desprendimiento seroso de retina&#46; El tub&#233;rculo coroideo regres&#243; lentamente con la terapia antituberculosa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discusi&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En pacientes con EC y en tratamiento con adalimumab&#44; un tub&#233;rculo coroideo puede presentarse sin sintomatolog&#237;a v&#237;treo-retiniana&#46;</p></span>"
        "secciones" => array:3 [
          0 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Caso cl&#237;nico"
          ]
          2 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Discusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Asensio-S&#225;nchez VM&#44; D&#237;az-Cabanas L&#44; Mart&#237;n-Prieto A&#44; Haro-&#193;lvarez B&#46; Tub&#233;rculo coroideo asintom&#225;tico en un paciente con enfermedad de Crohn en tratamiento con adalimumab&#46; Arch Soc Esp Oftalmol&#46; 2018&#59;93&#58;147&#8211;150&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 942
            "Ancho" => 950
            "Tamanyo" => 96427
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray with micronodular or miliary pattern&#44; showing small roundish nodules with clear edges distributed in both pulmonary fields&#44; 3 months after initiating therapy with adalimumab&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2958
            "Ancho" => 2833
            "Tamanyo" => 869480
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Normal right eye retinography&#46; &#40;B&#41; Left eye retinography&#44; showing choroidal subretinal tuber presenting as a solitary yellowish white nodule with uneven shape not associated with serous retinal detachment&#44; suggesting hematogenous dissemination of tuberculosis&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;C&#41; late arteriovenous phase of left eye fluorescein angiography showing increased fluorescence in late times&#46; &#40;D&#41; SD-OCT&#58; no neurosensory retina elevation or association with serous retinal detachment&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 752
            "Ancho" => 950
            "Tamanyo" => 69798
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Marginal retraction and depigmentation of the choroidal tuber after 6 months of antituberculostatic treatment&#46; The lesion shows improved edges&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy&#44; safety&#44; and predictors of response to infliximab therapy for ulcerative colitis&#58; a Korean multicenter retrospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;M&#46; Lee"
                            1 => "Y&#46;T&#46; Jeen"
                            2 => "J&#46;Y&#46; Cho"
                            3 => "C&#46;K&#46; Lee"
                            4 => "J&#46;S&#46; Koo"
                            5 => "D&#46;I&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgh.12324"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastroenterol Hepatol"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "1829"
                        "paginaFinal" => "1833"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23829336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcome of treatment with infliximab in Crohn&#39;s disease&#58; a single-center experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;J&#46; Kim"
                            1 => "J&#46;W&#46; Kim"
                            2 => "C&#46;K&#46; Lee"
                            3 => "H&#46;J&#46; Park"
                            4 => "J&#46;J&#46; Shim"
                            5 => "J&#46;Y&#46; Jang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Gastroenterol"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "270"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23756669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-authorization changes in the safety and efficacy assessment&#44; recommended indications&#44; and drug quality profile of adalimumab&#58; a chronological overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Iv&#225;nyi"
                            1 => "R&#46; Zelk&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5414/CP202705"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pharmacol Ther"
                        "fecha" => "2017"
                        "volumen" => "55"
                        "paginaInicial" => "133"
                        "paginaFinal" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27900937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early emergence of CD8&#43; T cells primed for production of type 1 cytokines in the lungs of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>-infected mice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;V&#46; Serbina"
                            1 => "J&#46;L&#46; Flynn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Immun"
                        "fecha" => "1999"
                        "volumen" => "67"
                        "paginaInicial" => "3980"
                        "paginaFinal" => "3988"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10417164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global tuberculosis report 2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "World Health Organization"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2014"
                        "editorial" => "World Health Organization"
                        "editorialLocalizacion" => "Geneva"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Solitary nonreactive choroidal tuberculoma in a patient with acquired immune deficiency syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; DiLoreto Jr&#46;"
                            1 => "N&#46;A&#46; Rao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2001"
                        "volumen" => "131"
                        "paginaInicial" => "138"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11162995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overview of benefit&#47;risk of biological agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;K&#46; Imperato"
                            1 => "C&#46;O&#46; Bingham 3rd"
                            2 => "S&#46;B&#46; Abramson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Exp Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "22"
                        "numero" => "5 Suppl 35"
                        "paginaInicial" => "S14"
                        "paginaFinal" => "S108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15515776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bilateral choroidal tuberculoma in miliary tuberculosis &#8211; report of a case"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Annamalai"
                            1 => "J&#46; Biswas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12348-014-0032-x"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Ophthalmic Inflamm Infect"
                        "fecha" => "2015"
                        "volumen" => "5"
                        "paginaInicial" => "4"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25861395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Choroidal tuberculoma as a presenting sign of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Arej"
                            1 => "A&#46; Fadlallah"
                            2 => "E&#46; Chelala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/IMCRJ.S119703"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Med Case Rep J"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "365"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27956845"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of tuberculosis in patients treated with TNF-&#945; antagonists&#58; a systematic review and meta-analysis of randomised controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Zhang"
                            1 => "W&#46; Fan"
                            2 => "G&#46; Yang"
                            3 => "Z&#46; Xu"
                            4 => "J&#46; Wang"
                            5 => "Q&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2016-012567"
                      "Revista" => array:3 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2017"
                        "paginaInicial" => "e012567"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735794/0000009300000003/v1_201803010437/S2173579417302074/v1_201803010437/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5812"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Short communications"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009300000003/v1_201803010437/S2173579417302074/v1_201803010437/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417302074?idApp=UINPBA00004N"
]
Article information
ISSN: 21735794
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2020 September 0 1 1

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos