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Kidd DP. Neurological involvement by Behçet's syndrome: clinical features, diagnosis, treatment and outcome. Pract Neurol 2023; 23:386-400. [PMID: 37775123 DOI: 10.1136/pn-2023-003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
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Chung SW, Lee JH, Ha YJ, Kang EH, Lee YJ. Recurrent focal myofasciitis of Behçet syndrome mimics infectious myofasciitis: a case report. JOURNAL OF RHEUMATIC DISEASES 2023; 30:268-271. [PMID: 37736593 PMCID: PMC10509642 DOI: 10.4078/jrd.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
Behçet syndrome (BS) is a chronic inflammatory disease with multiorgan manifestations. However, muscular involvement in BS has rarely been reported. Herein, we report the case of a 30-year-old male with BS who had recurring pain and swelling of the lower legs. The patient was administered antibiotics on several occasions as the condition was misinterpreted to be infectious myositis. Magnetic resonance imaging revealed myofascial involvement with focal necrotic lesions, and muscle biopsy revealed acute suppurative myositis with perivascular infiltration of polymorphonuclear leukocytes. His symptoms improved after treatment with corticosteroids. Azathioprine and colchicine therapy was beneficial for preventing further relapse after short-term corticosteroid treatment. Therefore, BS should be considered in the differential diagnosis of focal suppurative myofasciitis.
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Affiliation(s)
- Sang Wan Chung
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Joo Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Medical Device Development, Seoul National University Graduate School, Seongnam, Korea
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3
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Conticini E, d'Alessandro M, Al Khayyat SG, D'Alessandro R, D'Ignazio E, Pata AP, Vallifuoco G, Falsetti P, Baldi C, Bardelli M, Gentileschi S, Fabiani C, Mazzei MA, Guarnieri A, Bargagli E, Cantarini L, Frediani B. Inflammatory muscle involvement in systemic vasculitis: A systematic review. Autoimmun Rev 2021; 21:103029. [PMID: 34971804 DOI: 10.1016/j.autrev.2021.103029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 11/02/2022]
Abstract
Vasculitis are severe systemic autoimmune diseases which may involve different organs and systems. Conversely, muscles do not represent an organ commonly involved by systemic vasculitis and myositis is not include among any classification or diagnostic criterion of vasculitis. In this regard, we aimed to review the literature in order to report all the available evidence concerning the inflammatory involvement of muscle in patients affected by systemic vasculitis. We collected a total of 108 papers, for a sum of 395 patients affected by muscle vasculitis. Most of them suffered from medium and small vessels vasculitis (mainly polyarteritis nodosa and ANCA-associated vasculitis) or from vasculitis secondary to rheumatoid arthritis. Conversely, muscle involvement in case of large vessel vasculitis occurred seldom, while only few papers reported such occurrence in Kawasaki or Behçet's disease. Histological findings may differ, but the most common ones displayed a necrotizing vasculitis of perimysium vessels, while granulomatous vasculitis was assessed only in case of ANCA-associated vasculitis patients. Creatine kinase were usually within normal range, seldom elevated, while imaging findings were generally undistinguishable from the ones found in idiopathic inflammatory myopathies: magnetic resonance imaging displays signal hyperintensity in T2 and STIR scans, while few data exist for positron emission tomography. The presentation of the disease may be fearsome and severe, sometimes life-threatening, but an overall good response to conventional immunosuppressants and/or glucocorticoids has been reported.
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Affiliation(s)
- Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Roberto D'Alessandro
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Emilio D'Ignazio
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Anna Paola Pata
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Giulia Vallifuoco
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging Unit, Department of Medicine, Surgery and Neurosciences and Radiological Sciences, University of Siena, Italy
| | - Andrea Guarnieri
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy.
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
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4
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Kim KW, Cho JH. Muscular atrophy and weakness in the lower extremities in Behçet’s disease: A case report and review of literature. World J Clin Cases 2021; 9:5647-5654. [PMID: 34307620 PMCID: PMC8281428 DOI: 10.12998/wjcc.v9.i20.5647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Behçet’s disease (BD), very few cases of muscular involvement have been reported previously. The natural history and therapeutic protocol for muscular involvement in BD are obscure due to the low incidence of peripheral neuropathy or myopathy in BD. The purpose of our study was to report a rare case of BD with chronic, focal forms of neuromyopathy and review the relevant literature.
CASE SUMMARY We herein report the case of a 54-year-old man who presented with progressive muscular atrophy and weakness of both thighs 2 years after the presentation of the cardinal symptoms of BD. The past medical history, electrophysiological study, neurological examination, blood tests, magnetic resonance imaging study, and histological exam were performed for the differential diagnosis. Relevant literature on muscular involvement in BD was reviewed. Neurological examination revealed that muscular involvement was predominantly localized in the proximal parts of the lower extremities. Heterogeneous enhancement of several thigh muscles was observed on magnetic resonance imaging, which corresponded with the clinical manifestations. Histological study of one of the enhanced muscles showed denervation atrophy of the muscle with superimposed myopathic changes, while electrophysiological studies only suggested denervation.
CONCLUSION To our knowledge, this is the first case of neurogenic muscular atrophy with a specific set of clinical, radiological, electrophysiological, and histological findings reported in BD.
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Affiliation(s)
- Koh-Woon Kim
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Jae-Heung Cho
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Kyung Hee University, Seoul 02447, South Korea
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5
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Successful treatment of refractory Behçet’s myositis with Tumor Necrosis Factor inhibitor. HONG KONG BULLETIN ON RHEUMATIC DISEASES 2018. [DOI: 10.2478/hkbrd-2018-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We report a case of refractory Behçet’s disease (BD) with small foot muscle myositis, which required Magnetic Resonance Imaging (MRI) for diagnosis. It demonstrates that BD may take years to develop to a full-blown picture. Our patient’s disease activity was promptly under control with the administration of Tumor Necrosis Factor inhibitor (TNFi), namely Adalimumab, after the failure of multiple immunosuppressants. The prognosis of myositis in BD is usually favorable. Image-guided muscle biopsy and HLA-B51 gene testing may be required in an atypical case. Corticosteroids remain the key therapy for myositis in BD, while TNFi should be considered in refractory cases.
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Behcet's Disease: Is There Geographical Variation? A Review Far from the Silk Road. Int J Rheumatol 2015; 2015:945262. [PMID: 26798344 PMCID: PMC4698787 DOI: 10.1155/2015/945262] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 01/18/2023] Open
Abstract
Behcet's Disease (BD) is a systemic vasculitis characterized by the triad of recurrent mouth and genital ulcers with eye involvement. To date there are no laboratory tests specific for the disease and diagnosis continues to remain on clinical grounds. Multiple criteria have been created as guides for diagnosis; however, given the wide spectrum of organ involvement, some cases remain undiagnosed. The diagnosis of Behcet's Disease may only be made over time as the clinical manifestations emerge sometimes separated by months and even years. With an increased recognition of this disease it has become apparent that there is geographical variation in clinical manifestations. In particular cardiac manifestations are not seen commonly in Caucasians compared to Asian and Middle Eastern patients, while neurological manifestations are more common in Caucasians. Use of immunosuppressive and immunomodulatory drugs to suppress inflammation remains the cornerstone of treatment.
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Yilmaz S, Sanal HT, Cinar M, Karslıoglu Y. Muscle involvement in two Behçet cases: magnetic resonance imaging and histology findings. Jpn J Radiol 2014; 32:233-7. [PMID: 24452326 DOI: 10.1007/s11604-014-0284-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/07/2014] [Indexed: 01/30/2023]
Abstract
Behçet's disease (BD) is a systemic vasculitis with a classic trio of symptoms of oral aphthous ulcers, genital ulcers, and ocular lesions that present in a relapsing fashion. Despite these most frequently encountered symptoms of the disease, other systems such as vascular, gastrointestinal, and neurological involvements can also occur. Muscular involvement is rare, and there are only a few cases in the literature, which were reported mainly in a pediatric population. In this two-adult case report, muscular involvement of BD with an emphasis on magnetic resonance imaging and histology findings will be presented.
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Affiliation(s)
- Sedat Yilmaz
- Department of Rheumatology, Medical Faculty, Gulhane Military Medical Academy, Gn.Tevfik Saglam Cad., Kecioren, Ankara, 06018, Turkey
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8
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Lipid Storage Myopathy in Behçet's Disease: A Rare Cause of Elevated Serum Creatine Kinases Levels. Case Rep Rheumatol 2012; 2012:283259. [PMID: 22937450 PMCID: PMC3420721 DOI: 10.1155/2012/283259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/29/2012] [Indexed: 01/02/2023] Open
Abstract
Muscular involvement in Behçet's disease is rare and there are only a few case reports in the literature. The causes of elevated muscle enzymes in a patient with Behcet's disease are many, including myositis, drug-induced myopathy, metabolic myopathy, and the disease itself. We herein have defined an algorithmic approach to a patient with Behcet's disease and elevated muscle enzymes and report a case of coexisting of lipid storage myopathy.
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9
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Jo SE, Kim YJ, Lee KH, Cho SG, Lim MJ, Kwon SR, Park W, Hong SJ, Shin MJ. Muscular involvement of Behçet's disease: ultrasonography, computed tomography, and magnetic resonance imaging findings. Clin Imaging 2012; 36:643-6. [PMID: 22920383 DOI: 10.1016/j.clinimag.2011.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/29/2011] [Accepted: 11/11/2011] [Indexed: 02/07/2023]
Abstract
Behçet's disease (BD) is a form of systemic vasculitis with the classic triad of recurrent oral and genital ulcers along with uveitis. In BD, muscular involvement is very rare. We report a case of muscular involvement in BD with characteristic findings using ultrasonography, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Sung Ehn Jo
- Department of Radiology, Inha University Hospital, Incheon 400-711, Korea
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10
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Ogose T, Tamaki W, Shinahara K, Kaneko M, Wakata Y, Naruse K. A case of recurrent myositis as the main manifestation of Behçet disease. Pediatr Int 2010; 52:e101-4. [PMID: 20500454 DOI: 10.1111/j.1442-200x.2010.03082.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Takeshi Ogose
- Department of Pediatrics, National Hospital Organization, Kochi National Hospital, 1-2-25, Asakuranishimachi, Kochi 780-8077, Japan.
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11
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Stubbs AY, Taljanovic MS, Massey BZ, Graham AR, Friend CJ, Walsh JA. Myonecrosis of Behcet's disease. Skeletal Radiol 2008; 37:357-60. [PMID: 18259748 DOI: 10.1007/s00256-007-0432-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 11/13/2007] [Accepted: 11/23/2007] [Indexed: 02/02/2023]
Abstract
Behcet's disease is an inflammatory disease of unknown cause characterized by intermittent episodes of acute inflammation manifested by oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. We report a rare case of myonecrosis associated with Behcet's disease. Myonecrosis of Behcet's disease can mimic soft tissue abscess and therefore awareness of this entity in the appropriate clinical setting is important for initiation of appropriate and timely treatment.
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Affiliation(s)
- Alana Y Stubbs
- Department of Radiology, Southern Arizona Veterans Administration Health Care System, 3601 South 6th Avenue, Tucson, AZ 85723, USA.
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12
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Akansel G, Akgoz Y, Ciftci E, Arslan A, Demirci A. MRI findings of myositis in Behçet disease. Skeletal Radiol 2004; 33:426-8. [PMID: 15133638 DOI: 10.1007/s00256-003-0745-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 12/16/2003] [Indexed: 02/02/2023]
Abstract
We report the magnetic resonance imaging findings in a case of localized myositis in a 23-year-old man with long-standing Behçet disease.
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Affiliation(s)
- Gur Akansel
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Derince, Turkey.
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13
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Choi JA, Kim JE, Koh SH, Chung HW, Kang HS. Arthropathy in Behçet disease: MR imaging findings in two cases. Radiology 2003; 226:387-9. [PMID: 12563130 DOI: 10.1148/radiol.2262011982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Arthropathy is part of the protean manifestations of Behçet disease. Imaging findings reported thus far have been based on those of conventional radiography. Magnetic resonance imaging in two cases of Behçet disease with arthropathy demonstrated synovial thickening and effusion, as well as myositis manifested by high signal intensity on T2-weighted images.
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Affiliation(s)
- Jung-Ah Choi
- Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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14
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Taarit CB, Ben Turki S, Ben Maïz H. [Rheumatologic manifestations of Behcet's disease: report of 309 cases]. Rev Med Interne 2001; 22:1049-55. [PMID: 11817117 DOI: 10.1016/s0248-8663(01)00470-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To define the epidemiology and clinical features of Behçet's disease, giving special attention to unusual forms. METHODS We retrospectively reviewed the medical records of 309 cases with joint manifestations among 450 cases of Behçet's disease seen over a 20-year period who met the International Study Group of Behçet's disease criteria. RESULTS Joint manifestations were present in 68.3% and were inaugural in 34.5%. The knee and ankles were the joints most commonly affected. Monoarthritis, oligoarthritis and polyarthritis were seen respectively in 12, 13.5 and 19.8%. Sacroiliitis is observed in 6%. Unusual forms included destructive polyarthritis (two cases), popliteal cyst (two cases), myositis (two cases) and ankylosing spondylitis (two cases). CONCLUSION Joint manifestations are common in Behçet's disease. They are frequently associated with erythema nodosum and necrotic pseudofolliculitis. Polyarthritis is not rare. Their unusual forms deserve to be known.
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Affiliation(s)
- C B Taarit
- Service de néphrologie et de médecine interne, hôpital Charles-Nicolle, boulevard 9-Avril, 1006 BS Tunis, Tunisie
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Zen-nyoji M, Okamura S, Harada K, Igarashi S, Sunaga C, Oshimoto H, Onozato Y, Motegi K, Sakamoto T, Hayashi S, Saito S, Aoki T, Mori M. Intestinal Behçet's disease associated with generalized myositis. Gastrointest Endosc 2000; 51:359-61. [PMID: 10699793 DOI: 10.1016/s0016-5107(00)70373-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Zen-nyoji
- Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan
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16
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Abstract
The neurological complications of Behçet's syndrome have not been characterized with clarity. We present the clinical features, imaging characteristics and CSF findings of a series of 50 patients seen at the National Hospital for Neurology and Neurosurgery over the past 10 years. In this series, vascular complications had a low prevalence, whereas involvement of the brainstem was common; spinal cord lesions, hemisphere lesions and meningoencephalitis also occurred. Optic neuropathy, vestibulocochlear and peripheral nerve involvement occurred, but were rare. The prognosis for recovery was in general good, and the majority of those followed-up over a median of 3 years (range 1-19 years) had only single attacks. One-third of patients underwent further attacks, and four underwent progressive deterioration leading to disability. Factors suggesting a poor prognosis are repeated attacks, incomplete recovery, progressive disease course and a high level of CSF leucocytosis during acute attack. These data should be of help in the further definition of the clinical characteristics of this rare neurological disorder and in the planning of treatment trials.
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Affiliation(s)
- D Kidd
- The National Hospital for Neurology and Neurosurgery, London and the Departments of Immunology and Rheumatology, Northwick Park Hospital, Harrow, UK.
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17
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Kazarians H, Voelter HU, Schwendemann G. Muscular necrotizing vasculitis as the initial manifestation of Behçet's disease. Muscle Nerve 1999; 22:430-1. [PMID: 10086911 DOI: 10.1002/(sici)1097-4598(199903)22:3<430::aid-mus28>3.0.co;2-#] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Worthmann F, Bruns J, Türker T, Gosztonyi G. Muscular involvement in Behçet's disease: case report and review of the literature. Neuromuscul Disord 1996; 6:247-53. [PMID: 8887953 DOI: 10.1016/0960-8966(96)00019-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Acute necrotizing myositis is described in a 22-yr-old man with clinically diagnosed Behçet's disease. Light microscopic examination revealed a prominently granulocytic-monocytic infiltration of the muscle with severe necrosis. An infectious (bacterial, fungal or parasitic) etiology could be excluded by specific staining techniques and by immunohistochemistry. Vascular deposition of immune complexes was detected by direct immunofluorescence. Electron microscopy revealed severe structural damage and phagocytosis of muscle fibers. In the endomysium, leukocytes and occasional erythrocytes were found. Virus-like particles were not seen. The relevant literature on muscular involvement in Behçet's disease is reviewed. It is suggested that two different stages of inflammation occur in Behçet's disease. In the acute stage it presents as a granulocytic-monocytic necrotizing reaction developing from a neutrophil-mediated vasculitis. In the later phase lymphocytic infiltrations predominate. Despite the rare involvement of muscles the diagnosis of Behçet's disease should be considered particularly in younger patients presenting with muscular symptoms like pain and swelling pre-dominantly of the lower extremities.
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Affiliation(s)
- F Worthmann
- Institute of Neuropathology, Free University of Berlin, Germany
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19
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Abstract
A wide range of conditions can mimic polymyositis. Thus, diagnosing this condition can be a challenge. Although no single criterion is diagnostic of polymyositis, the following criteria have been proposed and widely used: (1) symmetric proximal muscle weakness; (2) characteristic violaceous rash on the hands, elbows, and knees; (3) increased muscle enzymes in the serum; (4) characteristic electromyographic findings (insertional activity, fibrillation potentials, motor unit potentials of increased frequency and decreased duration, and normal conduction velocity in nerves); and (5) muscle biopsy specimen with characteristic inflammatory and myopathic changes. Although polymyositis primarily involves muscle, up to 20% of patients may have extramuscular problems. The main treatment for polymyositis is high-dose corticosteroids. In corticosteroid-resistant patients, methotrexate is often effective. In this report, case histories are presented to highlight the usefulness and the limitations of the common diagnostic criteria for polymyositis.
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Affiliation(s)
- T W Bunch
- Division of Rheumatology, Mayo Clinic, Rochester, MN 55905
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20
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Lang BA, Laxer RM, Thorner P, Greenberg M, Silverman ED. Pediatric onset of Behçet's syndrome with myositis: case report and literature review illustrating unusual features. ARTHRITIS AND RHEUMATISM 1990; 33:418-25. [PMID: 2180406 DOI: 10.1002/art.1780330317] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of Behçet's syndrome with myositis in a pediatric patient, emphasizing the importance of muscle involvement in the differential diagnosis of calf pain and swelling in Behçet's syndrome. A review of the English-language literature from 1965 to the present suggests that the clinical picture of Behçet's syndrome in children differs from that in adults, in that there is a lower frequency of ocular disease, and unusual manifestations appear to be more common.
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Affiliation(s)
- B A Lang
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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22
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Abstract
This is the case report of a thirty-one-year-old woman who presented with a large skin lesion on a breast that was first thought to be a malignant or inflammatory process. After a biopsy, the lesion was diagnosed as nonspecific vasculitis. No similar case has been found in a review of the literature.
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Affiliation(s)
- S V Dündar
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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23
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Lakhanpal S, Tani K, Lie JT, Katoh K, Ishigatsubo Y, Ohokubo T. Pathologic features of Behçet's syndrome: a review of Japanese autopsy registry data. Hum Pathol 1985; 16:790-5. [PMID: 4018777 DOI: 10.1016/s0046-8177(85)80250-1] [Citation(s) in RCA: 240] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The data recorded from 170 autopsies of patients with Behçet's syndrome in Japan during the period from 1961 to 1976 were analyzed. The patients had been in the second to the eighth decade of life, and the ratio of males to females was 5 to 2. A wide spectrum of pathologic findings was observed, with involvement of neurologic, ophthalmic, cardiovascular, pulmonary, gastrointestinal, visceral, genitourinary, and mucocutaneous systems. Some of the common acknowledged clinical features of the syndrome, such as oral ulcers, synovitis, retinal and cutaneous vasculitis, and venous occlusions, were underreported. This apparent discrepancy in an autopsy series may be due to the effects of treatment or the healing process, as well as to the possible incompleteness of the postmortem examination. The accessibility of recorded data in a national autopsy registry offers a unique opportunity for review of the pathologic features of Behçet's syndrome.
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Frayha RA, Afifi AK, Bergman RA, Nader S, Bahuth NB. Neurogenic muscular atrophy in Behcet's disease. Clin Rheumatol 1985; 4:202-11. [PMID: 4006389 DOI: 10.1007/bf02032295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A child is reported with Behcet's disease who presented with skin and joint manifestations, oral ulcers, brainstem syndrome and neurogenic muscular atrophy. The neurogenic muscular atrophy was confirmed by electrophysiologic, histologic and histochemical studies. Electron microscopy of muscle showed a vasculopathy. The possible etiology of the muscle lesions is discussed. The relevant literature on muscle and peripheral nerve involvement in Behcet's disease is reviewed. It is proposed that neuromyopathy be added to the neurological manifestations of Behcet's disease. To our knowledge, this is the first case of neurogenic atrophy reported in Behcet's disease.
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Hamza M. Thrombophlebitis in Behçet's disease: two causes of diagnostic error. ARTHRITIS AND RHEUMATISM 1984; 27:717. [PMID: 6732889 DOI: 10.1002/art.1780270621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Di Giacomo V, Carmenini G, Meloni F, Valesini G. Myositis in Behçet's disease. ARTHRITIS AND RHEUMATISM 1982; 25:1025. [PMID: 7115448 DOI: 10.1002/art.1780250822] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Yazici H, Tüzüner N, Tüzün Y, Yurdakul S. Localized myositis in Behçet's disease. ARTHRITIS AND RHEUMATISM 1981; 24:636. [PMID: 7213444 DOI: 10.1002/art.1780240412] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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