<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1817-5996</journal-id>
<journal-title><![CDATA[Revista Cubana de Reumatología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cuba Reumatol]]></abbrev-journal-title>
<issn>1817-5996</issn>
<publisher>
<publisher-name><![CDATA[Editorial CIMEQ]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1817-59962020000100007</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Síndrome de CREST asociado a shock séptico por osteomielitis hematógena aguda]]></article-title>
<article-title xml:lang="en"><![CDATA[CREST syndrome associated with septic shock due to acute osteomyelitis hematologic]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Remedios Batista]]></surname>
<given-names><![CDATA[Susel Elisabet]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cruz González]]></surname>
<given-names><![CDATA[Zahili]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Medina Sánchez]]></surname>
<given-names><![CDATA[César]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Leyva]]></surname>
<given-names><![CDATA[Luz Midiala]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Ramayo]]></surname>
<given-names><![CDATA[Yurina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Ciencias Médicas de Holguín Hospital Clínico Quirúrgico Carlos Font Pupo ]]></institution>
<addr-line><![CDATA[Banes ]]></addr-line>
<country>Cuba</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<volume>22</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1817-59962020000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1817-59962020000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1817-59962020000100007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN El síndrome de CREST (calcinosis, fenómeno de Raynaud, dismotilidad esofágica, esclerodactilia, telangiectasias) forma parte del espectro clínico de la esclerosis sistémica, enfermedad del colágeno, denominada en la clasificación clínica como esclerodermia cutánea limitada. Se presenta un paciente masculino de 53 años, raza blanca y procedencia rural, que desde hace 10 años presenta poliartritis, cambios en zonas distales de la piel que subyace adherida al hueso, falanges de manos y pies, fenómeno de Raynaud, aparición de nódulos subcutáneos de pequeño tamaño en varias localizaciones, que luego se tornan calcificaciones. Llega con una úlcera en el quinto metatarsiano del pie izquierdo, de 14 meses de evolución con varios ingresos para tratamiento de la lesión con resolución aparente y luego recidiva. Desarrolla un cuadro de osteomielitis hematógena aguda con shock séptico. El tratamiento multidisciplinario y oportuno permitió la sobrevida del paciente.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT CREST's Syndrome (calcinosis, Raynaud's phenomenon, dysmotilitic esofhagical, sclerodactilitys, telanghiectasis), the form departs from the clinical spectrum of the Systemic Sclerosis, disease of collagen, named in the clinical classification like cutaneous limited scleroderma. Patient, masculine of 53 years, white race, peasant procedence. 10 years ago with changes at zones level distally of the skin that underlies once the bone was adhered, phalanges of hands and feet, Raynaud's phenomenon so big a child's appearing of subcutaneous nodules at several locations, that next calcifications appear. Ulcer in metatarsal foot left-hand fifth, of 14 months of evolution with multiple entrances for treatment of the lesion with apparent resolution and next relapse. Develop acute osteomyelitis hematologic with septic shock. The multi-disciplinary and opportune treatment enabled the patient's over-life.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[esclerosis sistémica]]></kwd>
<kwd lng="es"><![CDATA[síndrome de CREST]]></kwd>
<kwd lng="es"><![CDATA[osteomielitis hematógena aguda]]></kwd>
<kwd lng="es"><![CDATA[shock séptico]]></kwd>
<kwd lng="en"><![CDATA[Systemic sclerosis]]></kwd>
<kwd lng="en"><![CDATA[CREST Syndrome]]></kwd>
<kwd lng="en"><![CDATA[acute osteomyelitis hematologic]]></kwd>
<kwd lng="en"><![CDATA[septic shock]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Domsic]]></surname>
<given-names><![CDATA[RT]]></given-names>
</name>
<name>
<surname><![CDATA[Dezfulian]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Shoushtari]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Endothelial dysfunction is present only in the microvasculature and microcirculation of early diffuse systemic sclerosis patients]]></article-title>
<source><![CDATA[Clin Exp Rheumatol]]></source>
<year>2014</year>
<volume>32</volume>
<numero>^s86</numero>
<issue>^s86</issue>
<supplement>86</supplement>
<page-range>154-60</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fériz]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Louis]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Espinoza]]></surname>
<given-names><![CDATA[RL]]></given-names>
</name>
<name>
<surname><![CDATA[Khamashta]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Cerinic]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Sanmartí]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<source><![CDATA[Enfermedades inflamatorias reumatológicas]]></source>
<year>2016</year>
<publisher-loc><![CDATA[Medellín ]]></publisher-loc>
<publisher-name><![CDATA[Ed. Producciones científicas Ltda. PANLAR]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aïssou]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Meune]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Avouac]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Meunier]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Elhaï]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sorbets]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Small, medium but not large arteries are involved in digital ulcers associated with systemic sclerosis]]></article-title>
<source><![CDATA[Joint Bone Spine]]></source>
<year>2016</year>
<volume>83</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>444-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Remedios Batista]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
<name>
<surname><![CDATA[Montada Cedeño]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[del Campo Avilés]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Torres Pérez]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Fernández Portelles]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mecanismos etiopatogénicos en la esclerosis sistémica]]></article-title>
<source><![CDATA[CCM]]></source>
<year>2016</year>
<volume>20</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cutolo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Smith]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Furst]]></surname>
<given-names><![CDATA[DE]]></given-names>
</name>
<name>
<surname><![CDATA[Khanna]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Herrick]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Points to consider-Raynaud's phenomenon in systemic sclerosis]]></article-title>
<source><![CDATA[Rheumatology (Oxford)]]></source>
<year>2017</year>
<volume>56</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>45-8</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cantarini]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Rigante]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Vitale]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravenous immunoglobulins (IVIG) in sys-temic sclerosis a challenging yet promising future]]></article-title>
<source><![CDATA[Immunol Res]]></source>
<year>2015</year>
<volume>61</volume>
<page-range>326-37</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodhes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Evans]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Waleed Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Levy Mitchel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Actualización para las recomendaciones para el manejo de la sepsis y el shock séptico de la "Campaña para la supervivencia de la sepsis"]]></article-title>
<source><![CDATA[Rev Care Med]]></source>
<year>2017</year>
<volume>45</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>486-552</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ochoa Morales]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Cano Esquivel]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Tapia Ibáñez]]></surname>
<given-names><![CDATA[EX]]></given-names>
</name>
<name>
<surname><![CDATA[López Cruz]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez de los Reyes Barragán]]></surname>
<given-names><![CDATA[GR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Validación de la nueva definición de sepsis en el servicio de urgencias]]></article-title>
<source><![CDATA[Rev An Med (Mex)]]></source>
<year>2018</year>
<volume>63</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>6-13</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Deutschman]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Seymour Fuente]]></surname>
<given-names><![CDATA[CW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2016</year>
<volume>315</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>801-10</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ingegnoli]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Smith]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Sulli]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Cutolo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Capillaroscopy in routine diagnostics: Potentials and limitations]]></article-title>
<source><![CDATA[Curr Rheumatol Rev]]></source>
<year>2017</year>
<volume>14</volume>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Levy Mitchel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Evans]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Rodhes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Antonelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ferrer]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sepsis: actualizan recomendaciones para la primera hora]]></article-title>
<source><![CDATA[Rev Care Medicine]]></source>
<year>2018</year>
<volume>46</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>997-1000</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Medina]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Paciel]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Noceti]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Rieppi]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Actualización acerca de colistina (polimixina E): aspectos clínicos, PK/PD y equivalencias]]></article-title>
<source><![CDATA[Rev Méd Urug]]></source>
<year>2017</year>
<volume>33</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alvarez de Lara]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Garcia Montemayor]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ajuste de fármacos en la insuficiencia renal]]></article-title>
<source><![CDATA[Rev Esp Nefrolog]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rosales]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Rojas]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Zamora]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Izquierdo]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Benavides]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[El desafío en la dosificación de Colistin: actualización de las recomendaciones disponibles]]></article-title>
<source><![CDATA[Rev Chil Infectol]]></source>
<year>2018</year>
<volume>35</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaukonen]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Bailey]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pilcher]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Cooper]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Bellomo]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Systemic inflammatory response syndromecriteria in defining severe sepsis]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2015</year>
<volume>372</volume>
<numero>17</numero>
<issue>17</issue>
<page-range>1629-38</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
