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Background The intestinal microbiota is altered in patients with atopic dermatitis (AD) when compared with those of the healthy population. Some interventions with specific probiotic preparations already demonstrate a change in composition of this microbiota accompanied by improvement in the disease. Objectives This research work was designed to evaluate clinical efficacy of the probiotic preparation, and to measure the effect of the intervention on the total dose of corticosteroids administered to subjects. Methods This double-blind, randomized, placebo-controlled clinical trial including 70 participants with AD aged 4–17 years was designed to evaluate the clinical effect, compared with placebo, of a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum and Lactobacillus casei at a total daily consumption of 1 × 109 colony-forming units per capsule, over 12 weeks. After randomization and exclusion, 35 patients were allocated to probiotic and 35 to placebo. Clinical variables analysed were SCORAD (SCORing of Atopic Dermatitis) and Investigator Global Assessment (IGA) indices; effect on the amount of topical corticosteroids used; and assessment of safety. Results Mean SCORAD index at 12 weeks showed a statistically significant difference of −5.43 (95% confidence interval −10.65 to −0.21) between probiotic (SCORAD 13.52) and placebo groups (SCORAD 18.96); P = 0.04. Comparison between groups showed a statistically significant difference in the number of patients with IGA score improvement over the 12-week intervention: 29 of 32 (90.5%) in the probiotic group vs. 17 of 30 (56.7%) in the placebo group (P < 0.002). A comparison between groups of the proportions of days using corticosteroids and the total dose (g) of corticosteroids between baseline and end of study showed no significant difference, but between weeks 6 and 12 there was a statistically significant reduction in the probiotic group when compared with the placebo group in both variables. Numbers of adverse events were similar in both groups of treatment. Conclusions The probiotic mix used in this clinical trial demonstrated efficacy on the change in activity index of AD compared with placebo. Furthermore, the total number of days and total amount of topical corticosteroids required by participants in the probiotic group showed a significant reduction compared with placebo between 6 and 12 weeks.

The process of renal stone formation is complex, multifactorial, and variable depending on the type of stone. The microbiome, whether by direct or indirect action, is a factor that both promotes the formation and protects from developing of renal stones. It is a highly variable factor due to the great interindividual and intraindividual variability that it presents. In recent years, with the incorporation of nonculture-based techniques such as the high-throughput sequencing of 16S rRNA bacterian gene, both intestinal and urinary microbiota have been deeply studied in various diseases such as the kidney stone disease.This review has examined the new insights on the influence of the intestinal and urinary microbiome in nephrolithiasis disease and its usefulness as a diagnostic and prognostic tool, highlighting its contribution to the pathogenesis, its ability to modulate it and to influence disease development.The incidence of urolithiasis has been increasing considerably. These patients represent a significant expense for national health systems. With the knowledge of the influence of the urobiome and intestinal microbiota on the urolithiasis, it could be possible to modulate it to interrupt its development.

Background: The influence of the microbiome on neurological diseases has been studied for years. Recent findings have shown a different composition of gut microbiota detected in patients with multiple sclerosis (MS). The role of this dysbiosis is still unknown. Objective: We analyzed the gut microbiota of 15 patients with active relapsing-remitting multiple sclerosis (RRMS), comparing with diet-matched healthy controls. Method: To determine the composition of the gut microbiota, we performed high-throughput sequencing of the 16S ribosomal RNA gene. The specific amplified sequences were in the V3 and V4 regions of the 16S ribosomal RNA gene. Results: The gut microbiota of RRMS patients differed from healthy controls in the levels of the Lachnospiraceae, Ezakiella, Ruminococcaceae, Hungatella, Roseburia, Clostridium, Shuttleworthia, Poephyromonas, and Bilophila genera. All these genera were included in a logistic regression analysis to determine the sensitivity and the specificity of the test. Finally, the ROC (receiver operating characteristic) and AUC with a 95% CI were calculated and best-matched for Ezakiella (AUC of 75.0 and CI from 60.6 to 89.4) and Bilophila (AUC of 70.2 and CI from 50.1 to 90.4). Conclusions: There is a dysbiosis in the gut microbiota of RRMS patients. An analysis of the components of the microbiota suggests the role of some genera as a predictive factor of RRMS prognosis and diagnosis.

Alopecia areata is a multifactorial autoimmune-based disease with a complex pathogenesis. As in all autoimmune diseases, genetic predisposition is key. The collapse of the immune privilege of the hair follicle leading to scalp loss is a major pathogenic event in alopecia areata. The microbiota considered a bacterial ecosystem located in a specific area of the human body could somehow influence the pathogenesis of alopecia areata, as it occurs in other autoimmune diseases. Moreover, the Next Generation Sequencing of the 16S rRNA bacterial gene and the metagenomic methodology have provided an excellent characterization of the microbiota. The aim of this narrative review is to examine the published literature on the cutaneous and intestinal microbiota in alopecia areata to be able to establish a pathogenic link. In this review, we summarize the influence of the microbiota on the development of alopecia areata. We first introduce the general pathogenic mechanisms that cause alopecia areata to understand the influence that the microbiota may exert and then we summarize the studies that have been carried out on what type of gut and skin microbiota is found in patients with this disease.

Clostridiodes difficile can lead to a range of situations from the absence of symptoms (colonization) to severe diarrhea (infection). Disruption of gut microbiota provides an ideal environment for infection to occur. Comparison of gut microbiota of infected and colonized subjects could provide relevant information on susceptible groups or protectors to the development of infection, since the presence of certain genera could be related to the inhibition of transition from a state of colonization to infection. Through high-throughput sequencing of 16S rDNA gene, we performed alpha and beta diversity and composition studies on 15 infected patients (Group CDI), 15 colonized subjects (Group P), and 15 healthy controls (Group CTLR). A loss of alpha diversity and richness and a different structure have been evidenced in the CDI and P groups with respect to the CTRL group, but without significant differences between the first two. In CDI and P groups, there was a strong decrease in phylum Firmicutes and an expansion of potential pathogens. Likewise, there was a loss of inhibitory genus of C. difficile germination in infected patients that were partially conserved in colonized subjects. Therefore, infected and colonized subjects presented a gut microbiota that was completely different from that of healthy controls, although similar to each other. It is in composition where we found that colonized subjects, especially in minority genera, presented differences with respect to those infected.

Understanding the characteristics of the vaginal microbiota of our patients allows us to carry out both a personalized therapeutic approach and a closer follow-up in those with microbiota susceptible to dysbiosis. This trial pursues the analysis of the vaginal microbiota of premenopausal women and its fluctuations within a four-week follow-up period. Vaginal samples of 76 fertile women were taken at a baseline visit and at a final visit (day 28 ± 5). To perform a phylogenetic study, we employed massive sequencing techniques to detect the 16S rRNA gene of the vaginal microbiota. The most prevalent vaginal microbial community was type I (34.87%), dominated by Lactobacillus crispatus. Vaginal microbial community types II (Lactobacillus gasseri) and V (Lactobacillus jensenii) were underrepresented in our population. When repeating the sampling process four weeks later, 75% of our patients maintained their initial bacterial community. In the follicular phase, the most recurrent microbiota was type III (Lactobacillus iners), in the periovulatory phase, types III and IV (microbial diversity), finally, in the luteal phase, the most frequent type was IV. The most prevalent vaginal bacterial community in our population was dominated by L. crispatus. The vaginal microbiota was resistant to changes in its bacterial community in 75% of our patients, even between consecutive menstrual cycles.

is missing (Erratum)

Introduction/Background The human papillomavirus (HPV) infects 75% of sexually active women. Most of these infections are transitory and resolve spontaneously in less than two years. The persistence of high grade HPV genotypes is the main risk factor for cervical cancer and its precursory lesions. Recently, new evidence suggests that the state of vaginal microbiota plays an important role in the persistence and elimination of HPV. The main objective of our study is to observe the changes on the HPV infection and its intraepithelial cervical lesions after a long term administration of an specific oral probiotic formulation. Methodology The study is a randomize double-blinded clinical intervention trial. The sample will be taken from patients that attend the Gynecological consult of Hospital Universitario de Torrevieja, Spain, from 2018–2020. They must comply with the inclusion and exclusion criteria. The study has been divided in two parts. In Part I, we will analyze the vaginal samples taken after the oral administration of the probiotic to a large sample of patients for 28 days. In this part, we will evaluate the presence of the probiotic strain in vaginal microbiota. In Part II, the treatment with probiotic vs placebo, will be administered to HPV-positive women and observe its effect on the infection status and its cervical lesions. Results Preliminary results in Part I (ended on April 30th,2019) demonstrated, using massive sequencing techniques, that the administration of the oral probiotic allows for its vaginal colonization (Results details will be shown on the poster). Conclusion Through this study we attempt to demonstrate that an oral probiotic can colonize the vagina and consequently change its microbiota. In Part II of the study, we will study if an oral probiotic facilitates the elimination of HPV. In consequence, we would achieved to decrease the persistence of the intraepithelial cervical lesions, and therefore, cervical cancer. Disclosure Nothing to disclose

Introduction: The objective of this study was to identify trends in requests for anti-thyroid peroxidase antibodies (TPOab) and anti-thyroglobulin antibodies (TGab) tests before and after applying set of interventions based on rejection rules and profile management. Materials and methods: Trend analysis was made at semester time intervals (from May-October 2010 to May-October 2017), before and after the intervention semester (May-October 2016). Number of tests (N) TPOab and TGab / 1000 total requests based on total N of both tests and total N of biochemical analysis laboratory requests, was calculated. To find out where the interventions had more impact we distinguished N of requests between Primary Care (PC) and Specialized Care (SC). A joinpoint regression analysis was used to determine time segments and time points in these indicators where the trend changed. Results: Trend analysis of the request of TPOab and TGab showed two clearly differentiated trend lines with a statistically significant Joinpoint (P < 0.001) with an increase in each semester from May 2010 of 7.4% and 7.5% respectively, to the semester of the interventions where there was a decrease of - 45% and - 61% located mainly in PC. Trend analysis in SC setting did not show any Joinpoint and any trend line. Conclusions: Results showed that applied interventions enabled change of trend for TPOab and TGab test requests, especially in PC where the interventions proved to be the most successful.

Since the last 5–10 years the relevance of the gut microbiome on different intestinal illnesses has been revealed. Recent findings indicate the effect of gut microbiome on certain dermatological diseases such as atopic dermatitis. However, data on other skin diseases such as psoriasis are limited. This is the first time attempting to reveal the gut microbiome composition of psoriatic patients with a prospective study including a group of patients with plaque psoriasis, analyzing their gut microbiome and the relationship between the microbiome composition and bacterial translocation. The microbiome of a cohort of 52 psoriatic patients (PASI score ≥6) was obtained by 16s rRNA massive sequencing with MiSeq platform (Illumina inc, San Diego) with an average of 85,000 sequences per sample. The study of the gut microbiome and enterotype shows from the first time a specific “psoriatic core intestinal microbiome” that clearly differs from the one present in healthy population. In addition, those psoriatic patients classified as belonging to enterotype 2 tended to experience more frequent bacterial translocation and higher inflammatory status (71%) than patients with other enterotypes (16% for enterotype 1; and 21% for enterotype 3). Medicina

We conducted a phase IV randomized, double-blind, placebo-controlled, pilot clinical trial to investigate the safety and efficacy of oral curcumin together with local phototherapy in patients with plaque psoriasis. Patients with moderate to severe psoriasis received Curcuma extract orally with real visible light phototherapy (VLRT) or simulated visible light phototherapy (VLST) in the experimental area, while the rest of the body surface was treated with ultraviolet A (UVA) radiation. The endpoints were the number of responders and the temporal course of the response. The secondary outcomes were related to safety and adverse events. Twenty-one patients were included in the study. In the intention-to-treat analysis, no patients included in the VLRT group showed “moderate” or “severe” plaques after the treatment, in contrast to the patients included in the VSLT group (p

Internet is a resource to search for health-related information. The aim of this work was to know the content of the videos in Spanish language of YouTube related to the vaccine against the human papilloma virus (HPV).An observational study was conducted from a search on YouTube on 26th July 2013 by using keywords such as: "human papilloma virus vaccine", "HPV vaccine", "Gardasil vaccine", "Cervarix vaccine". Different categories were established according to: the type of vaccine, the published source and the favorable or unfavorable predisposition towards the human papillomavirus vaccination. The number of visits and the duration of the videos were gathered, with analysis of variables in the 20 most visited videos.A total of 170 videos were classified like: local news (n=39; 37 favorable, 2 unfavorable; 2:06:29; 42972 visits), national news (n=32; 30/2; 1:49:27; 50138 visits), created by YouTube subscribers (n=21; 21/1; 1:44:39; 10991 visits), advertisements (n=21; 19/2; 0:27:05; 28435 visits), conferences (n=17; 15/2; 3:25:39; 27206 visits), documentaries (n=16; 12/4; 2:11:31; 30629 visits). From all of the 20 most viewed YouTube videos predominated those which were favorable to the vaccination (n=12; 0:43:43; 161789 visits) against the unfavorable (n=8; 2:44:14; 86583 visits).Most of the videos have a favorable opinion towards HPV vaccine, although videos with a negative content were the longest and most viewed.

Cervical cancer (CC), the second most common cause of cancer deaths in women, is associated with the infection of human papillomavirus (HPV) and is more prevalent in women between the ages of 20 and 24. This research is aimed to determine the background about CC, the human papillomavirus infection and its vaccine, assessing its acceptability in university students.Cross-sectional study over 1,750 students from the University of Alicante (2008) selected at random, proportional associated to gender and studies, by a validated ad-hoc questionnaire. Percentages were computed, confidence intervals, contingency tables according to sex, age and type of studies, calculating adjusted odd ratios (OR).A sample with 58.6 % of women and 6.6% of biohealth students was obtained. 87.3% were willing to have the vaccine to prevent human papillomavirus (HPV), 94.3% would give this vaccine to their daughters, and 48.0% had heard someone talk about the vaccine. 90.6% didn't have a lot of knowledge about the HPV infection and 82.2% didn't know much about the vaccine. 22.4% had knowledge of the association between HPV and CC. Women register higher OR in acknowledging the problem and are more receptive to having the vaccine. The HPV vaccine acceptability is associated to the sex, the confidence of vaccines as a preventive method; the influence of the background is low in relation to the vaccine predisposition.A high acceptability of the vaccine was observed in the period of the study. Raising confidence in people about the vaccines can influence for a better predisposition to be vaccinated.

Oral intake of new probiotic formulations may improve the course of atopic dermatitis (AD) in a young population.To determine whether a mixture of oral probiotics is safe and effective in the treatment of AD symptoms and to evaluate its influence on the use of topical steroids in a young population.A 12-week randomized, double-blind, placebo-controlled intervention trial, from March to June 2016, at the outpatient hospital Centro Dermatológico Estético de Alicante, Alicante, Spain. Observers were blinded to patient groupings. Participants were children aged 4 to 17 years with moderate atopic dermatitis. The groups were stratified and block randomized according to sex, age, and age of onset. Patients were ineligible if they had used systemic immunosuppressive drugs in the previous 3 months or antibiotics in the previous 2 weeks or had a concomitant diagnosis of intestinal bowel disease or signs of bacterial infection.Twelve weeks with a daily capsule containing freeze-dried powder with 109 total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 and maltodextrin as a carrier, or placebo (maltodextrin-only capsules).SCORAD index score and days of topical steroid use were analyzed.Fifty children (26 [50%] female; mean [SD] age, 9.2 [3.7] years) participated. After 12 weeks of follow-up, the mean reduction in the SCORAD index in the probiotic group was 19.2 points greater than in the control group (mean difference, -19.2; 95% CI, -15.0 to -23.4). In relative terms, we observed a change of -83% (95% CI, -95% to -70%) in the probiotic group and -24% (95% CI, -36% to -11%) in the placebo group (P .001). We found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2084 patient-days [7.7%]) compared with the control arm (220 of 2032 patient-days [10.8%]; odds ratio, 0.63; 95% CI, 0.51 to 0.78).The mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD.clinicaltrials.gov Identifier: NCT02585986.

Fundamentos: Internet constituye un recurso de búsqueda de información relacionada con la salud. El objetivo de este trabajo fue conocer las características de los vídeos en idioma español de YouTube relacionados con la vacuna contra el virus del papiloma humano (VPH). Métodos: Se realizó un estudio observacional a partir de una búsqueda en YouTube el 26 de julio de 2013, con las palabras claves: “vacuna virus papiloma humano”, “vacuna VPH”, “vacuna Gardasil”, “vacuna Cervarix”. Se establecieron categorías por tipo, fuente de publicación y predisposición favorable o no hacia la vacuna. Se registró el número de visitas, tiempo de duración de los videos y origen de los 20 vídeos más visitados. Resultados. Se encontraron 1.080 videos registrados, 170 fueron seleccionados y clasificados como: noticias locales (n=39; 37 favorables, 2 desfavorables; 2:06:29; 42972 visitas), noticias nacionales (n=32; 30/2; 1:49:27; 50138 visitas), creados por subscritores de YouTube (n=21; 13/8; 2:50:35; 144655 visitas), entrevistas (n=21; 20/1; 1:44:39; 10991 visitas), anuncios (n=21; 19/2; 0:27:05; 28435 visitas), conferencias (n=17; 15/2; 3:25:39; 27206 visitas), documentales (n=16; 12/4; 2:11:31; 30629 visitas), y noticias internacionales (n=3; 3/0; 0:11:33; 1667 visitas). De los 20 videos más reproducidos predominan los favorables a la vacunación (n=12; 0:43:43; 161.789 visitas) frente a los desfavorables (n=8; 2:44:14; 86.583 visitas). Conclusiones. Predominan los videos que tiene una opinión favorable hacia la vacuna contra el VPH, aunque los videos de contenido negativo son los más extensos y reproducidos. Background. Internet is a resource to search for health-related information. The aim of this work was to know the content of the videos in Spanish language of YouTube related to the vaccine against the human papilloma virus (HPV). Metthods. An observational study was conducted from a search on YouTube on 26th July 2013 by using keywords such as: “human papilloma virus vaccine”, “HPV vaccine”, “Gardasil vaccine”, “Cervarix vaccine”. Different categories were established according to: the type of vaccine, the published source and the favorable or unfavorable predisposition towards the human papillomavirus vaccination. The number of visits and the duration of the videos were gathered, with analysis of variables in the 20 most visited videos. Results. A total of 170 videos were classified like: local news (n=39; 37 favorable, 2 unfavorable; 2:06:29; 42972 visits), national news (n=32; 30/2; 1:49:27; 50138 visits), created by YouTube subscribers (n=21; 21/1; 1:44:39; 10991 visits), advertisements (n=21; 19/2; 0:27:05; 28435 visits), conferences (n=17; 15/2; 3:25:39; 27206 visits), documentaries (n=16; 12/4; 2:11:31; 30629 visits). From all of the 20 most viewed YouTube videos predominated those which were favorable to the vaccination (n=12; 0:43:43; 161789 visits) against the unfavorable (n=8; 2:44:14; 86583 visits). Conclusions. Most of the videos have a favorable opinion towards HPV vaccine, although videos with a negative content were the longest and most viewed.

We report a 48-year-old male admitted to hospital due to a severe alcoholic pancreatitis. At four weeks of evolution of the acute episode, an abdominal CAT scan showed a fluid collection of 20 cm diameter located in the pancreatic tail and 2 small collections in the head. The patient received several antimicrobials and during the seventh week of evolution, while receiving vancomycin, presented fever. A fine needle aspiration of the cyst revealed the presence of Haemophilus parainfluenzae biotype VIII. The patient was treated with amoxicillin-clavulanic acid and a laparoscopic cysto-gastrostomy, with a good clinical response.

Summary Frontal fibrosing alopecia (FFA) is a distinctive form of scarring alopecia presenting with partial eyebrow loss and frontal temporal parietal recession of the hairline. Its etiology remains unknown, and there is no definitive treatment. Information in familial cases of FFA is scarce. We conducted a retrospective cohort study describing the mean clinical findings, treatment, and also the mean differences between premenopausal and postmenopausal cases of familiar FFA. Data analysis from case was performed on eight patients with a familiar history and diagnosis of FFA seen at the Alicante Aesthetic Dermatology Centre between January 2009 and June 2014. All patients in this cohort were females. Mean age at onset was 65 year (range 60–75) in the postmenopausal patients and 39 year (range 33–47) in the premenopausal women. All menopausal patients were in an advanced stage when the disease had already developed in the frontal and/or temporal parietal hairline region. However, the daughters, all of them premenopausal age, attended the consultation with mild involvement of the eyebrows in all four cases and mild impairment of the frontal hairline in three of them. Specific clinical findings in familial FFA are poorly communicated until nowadays although the number of familial cases arises until 8% in the main case series published in recent years. Early diagnosis in premenopausal stage is frequent in our case series and allows us to begin the protocol treatment in the first stage of the disease, but long-term progression will remain uncertain until a definitive treatment could be established by multicenter randomized controlled trials.

We report a 48-year-old male admitted to hospital due to a severe alcoholic pancreatitis. At four weeks of evolution of the acute episode, an abdominal CAT scan showed a fluid collection of 20 cm diameter located in the pancreatic tail and 2 small collections in the head. The patient received several antimicrobials and during the seventh week of evolution, while receiving vancomycin, presented fever. A fine needle aspiration of the cyst revealed the presence of Haemophilus parainfluenzae biotype VIII. The patient was treated with amoxicillin-clavulanic acid and a laparoscopic cysto-gastrostomy, with a good clinical response.

Aims: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. Methods: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. Results: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06—3.38) in 1987 to OR=3.62 (95% CI: 2.95—4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89—2.72) and OR=2.94 (95% CI: 2.36—3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39—5.45) in 1987 to 4.85 (95% CI: 3.06—7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39—3.08) and OR=4.16 (95% CI: 2.52—6.89). Conclusions: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.

Article Tables References Comments Psoriasis is a systemic autoimmune inflammatory disease that shares some immunological aspects with other inflammatory-based diseases, such as Crohn disease.1 Bacterial DNA (bactDNA) fragments have been shown to induce a systemic immunological response in Crohn disease and other settings.2,3 Although the results of most blood bacterial cultures are negative in patients with psoriasis, we hypothesized that the presence of bactDNA in the blood might act as a molecular trigger in disease outbreaks and induce a systemic inflammatory response in these patients.

En nuestrocaso, dado que el unico hallazgo de los estudios comple-mentarios fue la alteracion observada en la mucosa gas-trica, la diarrea podria responder a otra etiologia, infeccio-sa o no. No obstante, contamos con varias determinacionesque descartaron potenciales causas de diarrea cronica eneste paciente, lo cual, junto con la rapida respuesta al tra-tamiento antifungico con itraconazol, frecuente en lainfeccion por

Se trata de una mujer de 31 anos de edad, procedente de Marruecos y residente en Espana desde hacia 3 semanas. Desde hace 15 anos referia una tumoracion en la zona anterior del muslo izquierdo que no le producia dolor o fiebre pero que habia aumentado de tamano en los ultimos meses. Acudio a urgencias por dolor en el area de la tumoracion, sensacion distermica e impotencia funcional de 3 dias de evolucion. En la exploracion fisica la enferma estaba afebril y con buen estado general. No se palpaban adenopatias y la exploracion cardiopulmonar, abdominal y neurologica no mostraba alteraciones. Se objetivo una tumoracion indurada de gran tamano en la cara anterior e interna del muslo izquierdo, dolorosa, de consistencia elastica, sensible al tacto y sin signos inflamatorios superficiales (fig. 1). En la analitica destaco: leucocitos 6.670/ l (580 eosinofilos), Hb: 12,3 g/dl, Hto 36% y velocidad de sedimentacion globular 28 mm/h. Se realizo una radiografia lateral de la pierna izquierda en la que existia un aumento de densidad de partes blandas en la zona interna del muslo izquierdo, sin afectacion osea. La ecografia del muslo izquierdo mostro una masa con varios nodulos anecogenicos bien delimitados y de distinto tamano, compatibles con quistes. La tomografia computarizada (TC) evidencio una tumoracion quistica y multiloculada de 14 × 9 × 5 cm, que no realzaba tras la administracion de contraste, originada en el musculo pectineo con afectacion de musculos aductores (fig. 2). El Mantoux y la serologia para el virus de la inmunodeficiencia humana fueron negativas.