1
|
Derbel A, Snoussi M, Ghribi M, Ben Hamad M, Damak C, Frikha F, Marzouk S, Bahloul Z. Recurrent intra-cardiac thrombosis: A rare manifestation of Behçet's disease. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:115-117. [PMID: 38697708 DOI: 10.1016/j.jdmv.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
Behçet's disease is a systemic vasculitis characterized by recurrent bipolar aphtosis and ophthalmic disorders. Cardiac involvement is rarely reported and could be associated to poor prognosis. Intracardiac thrombosis is exceptional and represents a therapeutic issue. We report the case of a young man admitted in internal medicine department for management of prolonged fever and recurrent mouth ulcers.
Collapse
Affiliation(s)
- Abir Derbel
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia.
| | - Mouna Snoussi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mariem Ghribi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mayeda Ben Hamad
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Chifa Damak
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Sameh Marzouk
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| |
Collapse
|
2
|
Mezzetti E, Costantino A, Leoni M, Pieretti R, Di Paolo M, Frati P, Maiese A, Fineschi V. Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1364. [PMID: 37629654 PMCID: PMC10456745 DOI: 10.3390/medicina59081364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Autoimmune heart disease is a non-random condition characterised by immune system-mediated aggression against cardiac tissue. Cardiac changes often exhibit nonspecific features and, if unrecognised, can result in fatal outcomes even among seemingly healthy young individuals. In the absence of reliable medical history, the primary challenge lies in differentiating between the various cardiopathies. Numerous immunohistochemical and genetic studies have endeavoured to characterise distinct types of cardiopathies, facilitating their differentiation during autopsy examinations. However, the presence of a standardised protocol that forensic pathologists can employ to guide their investigations would be beneficial. Hence, this summary aims to present the spectrum of autoimmune cardiopathies, including emerging insights such as SARS-CoV-2-induced cardiopathies, and proposes the utilisation of practical tools, such as blood markers, to aid forensic pathologists in their routine practice.
Collapse
Affiliation(s)
- Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Andrea Costantino
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Matteo Leoni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Rebecca Pieretti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (P.F.); (V.F.)
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (P.F.); (V.F.)
| |
Collapse
|
3
|
Maaroufi AA, Abouradi SS, Hayar SS, Drighil AA. Giant right ventricular thrombus as the revealing form of Behçet's disease. Egypt Heart J 2023; 75:27. [PMID: 37039924 PMCID: PMC10090246 DOI: 10.1186/s43044-023-00354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Behçet's disease BD is a rare multisystemic disease, with rare cardiac involvement. This case illustrates a rare cardiac involvement as a giant intracavitary thrombus which was the revealing form of Behçet disease. CASE PRESENTATION An 15-year-old male admitted to the emergency department for progressive dyspnoea, hemoptysis for which an echocardiogram displayed a large echogenic mass in the right ventricle and angio CT revealed associated bilateral pulmonary embolism. The patient was then proposed for surgery for removal and pathological study the later confirmed its fibrin thrombotic nature. Behçet disease was suspected based on past history of recurrent oral aphthosis and confirmed with a positive pathergy test. Further management by anticoagulants, immunosuppressants and corticosteroids seemed effective to avoid relapse. CONCLUSIONS Cardiac involvement during BD can be life-threatening as it is not always diagnosed in timely manner. However, intracardiac thrombus is uncommon with only few case reports. Echocardiography is the key tool for the diagnosis of intracardiac thrombus.
Collapse
Affiliation(s)
- Anass A Maaroufi
- Cardiology Department, Ibn Rochd University Hospital, 20250, Casablanca, Morocco.
| | - Sara S Abouradi
- Cardiology Department, Ibn Rochd University Hospital, 20250, Casablanca, Morocco
| | - Salah S Hayar
- Cardiology Department, Ibn Rochd University Hospital, 20250, Casablanca, Morocco
| | - Abdenacer A Drighil
- Cardiology Department, Ibn Rochd University Hospital, 20250, Casablanca, Morocco
| |
Collapse
|
4
|
Smaali J, Charef A, Bamous M, Fatihi J, Amezian T. Anasarca Revealing Severe Cardiac Involvement Due to Behçet's Disease (BD): A Case Report. Cureus 2023; 15:e34532. [PMID: 36879693 PMCID: PMC9984977 DOI: 10.7759/cureus.34532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Behçet's disease (BD) is a systemic vasculitis which is most often manifested by recurrent oral aphthosis, genital aphthosis, and ocular involvement with sometimes visceral damage, in particular neurological, digestive, vascular, or renal. We report the case of a 21-year-old man admitted for anasarca who revealed severe cardiac involvement associating endomyocardial fibrosis, intracardiac thrombi and involvement of the tricuspid valve in the context of BD diagnosed a posteriori. Cardiac involvement is exceptional during BD, especially as a mode of entry into the disease. It can be particularly severe, hence the need for early diagnosis, rapid and sometimes aggressive management. Close monitoring is also necessary in order to watch for the occurrence of visceral manifestations, particularly in young patients.
Collapse
Affiliation(s)
- Jihane Smaali
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR.,Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, MAR
| | - Amal Charef
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Mehdi Bamous
- Cardiac Surgery, Mohammed V Military Training Hospital, Rabat, MAR
| | - Jamal Fatihi
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Taoufik Amezian
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| |
Collapse
|
5
|
Kechida M, Salah S, Kahloun R, Klii R, Hammami S, Khochtali I. Cardiac and vascular complications of Behçet disease in the Tunisian context: clinical characteristics and predictive factors. Adv Rheumatol 2018; 58:32. [PMID: 30657088 DOI: 10.1186/s42358-018-0032-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac and vascular involvement in Behçet disease (BD), also referred as vasculo BD, is frequent. We aimed to describe clinical characteristics, predictive factors and management of vasculo BD in the Tunisian context. METHODS We retrospectively studied 213 records of all BD patients followed between January 2004 and May 2016 in the Internal Medicine Department and who fulfilled the ISGBD criteria. We described first clinical features of BD with cardiac and vascular involvement then predictive factors were studied in univariate then multivariate analysis. RESULTS Among the 213 patients, 64 (30%) were diagnosed as having vasculo BD. The mean age at diagnosis was 31.5 years. About 81.25% of them were males and 18.75% females. Vascular involvement associated or not with cardiac involvement was found in 64 patients (30%). Deep venous thromboses are most common (62.5%) compared with superficial ones (23.4%), pulmonary arterial thrombosis (14.1%) or aneurysms (9.4%). Cardiac involvement is ranging from pericarditis (1.6%) to intra cardiac thrombosis (3.1%) and myocardial infarction (1.6%). Predictive factors associated with cardiac and vascular involvement in BD are male gender (OR = 3.043, 95% CI = 1.436-6.447, p = 0.004), erythema nodosum (OR = 4.134, 95% CI = 1.541-11.091, p = 0.005) and neurologic involvement (OR = 2.46, 95% CI = 1.02-5.89, p = 0.043). CONCLUSION Cardiac and vascular involvement in BD is frequent in the Tunisian context with a broad spectrum of manifestations ranging from vascular involvement to cardiac one. Male gender, patients with erythema nodosum or neurologic involvement are prone to develop cardiac or vascular features of BD needing therefore a close monitoring.
Collapse
Affiliation(s)
- Melek Kechida
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, 1st June Avenue, 5000, Monastir, Tunisia.
| | - Sana Salah
- Physical Medicine and Rehabilitaion Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rim Kahloun
- Ophtalmology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rim Klii
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, 1st June Avenue, 5000, Monastir, Tunisia
| | - Sonia Hammami
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, 1st June Avenue, 5000, Monastir, Tunisia
| | - Ines Khochtali
- Internal Medicine and Endocrinology Department, Fattouma Bourguiba University Hospital, 1st June Avenue, 5000, Monastir, Tunisia
| |
Collapse
|
6
|
Fichelle JM, Baissas V, Salvi S, Fabiani JN. [Superior vena cava thrombosis or stricture secondary to implanted central venous access: Six cases of endovascular and direct surgical treatment in cancer patients]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 43:20-28. [PMID: 29425537 DOI: 10.1016/j.jdmv.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
Superior vena cava (SVC) stenosis or thrombosis is a well-known complication of central venous catheterization for endocavitary treatments, hemodialysis, or chemotherapy. In cancer patients, these SVC lesions are often symptomatic due to intimal damage and chemotherapy toxicity. We report our experience with six patients treated between 2007 and 2012 via an endovascular approach (n=5) or a direct surgical approach (n=1). All patients had SVC syndrome with facial edema, headache and upper limb edema. In three cases, the catheter was in place when the clinical symptoms occurred. Duplex Doppler and computed tomography (CT)-angiography identified the following lesions: isolated SVC stenosis (n=2); SVC stenosis with right Pirogoff confluence stenosis (n=1); SVC stenosis associated with left innominate vein thrombosis and right Pirogoff confluence stenosis (n=1); SVC thrombosis affecting azygos flow (n=2). In one patient, the thrombus extended into the right atrium. Five patients underwent endovascular repair via a right jugular approach (n=2) or a double jugular approach (n=3). Treatment involved: SVC angioplasty with stent (n=2); right Pirogoff angioplasty and SVC stent (n=1); kissing angioplasty of both innominate trunks with a SVC stent (n=1); and SVC angioplasty without stent because of an incomplete result with a residual lumen less than 8mm (n=1). One patient had a complete SVC occlusion with extension of thrombus into the right atrium. She was treated via a median sternotomy for open surgical control of both innominate trunks and lateral clamping of the right atrium. A long cavotomy prolonged on the right atrium allowed thrombo-intimectomy and pericardial patch angioplasty. Postoperative follow-up was uneventful in five cases. However, postoperative hemorrhage required pericardial drainage in one patient. The CT scan showed a good morphological aspect in five patients and an incomplete result in one case. Patients have been followed up annually with a duplex scan from two to six years. One patient had a restenosis at 7 months treated by a new angioplasty via a femoral approach. A new catheter was positioned via a cervical approach. Two patients died of metastatic diffusion at 8 and 32 months. The other four patients have remained asymptomatic, with a satisfactory duplex scan. In conclusion, VCS lesions after implanted central access for chemotherapy can often be treated endovascularly. Conventional surgery still has indications when lesions extend into the right atrium.
Collapse
Affiliation(s)
- J M Fichelle
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - V Baissas
- Clinique Bizet, 21, rue Georges-Bizet, 75116 Paris, France; Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - S Salvi
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J N Fabiani
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
7
|
Nya F, Abdou A, Bamous M, Moutakiallah Y, Atmani N, Seghrouchni A, Houssa MA, Boulahya A. [Cardiac pseudotumor revealing Behçet's disease]. Pan Afr Med J 2017; 26:151. [PMID: 28533874 PMCID: PMC5429457 DOI: 10.11604/pamj.2017.26.151.11478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/18/2017] [Indexed: 11/19/2022] Open
Abstract
La thrombose intracardiaque est une complication rare de la maladie de Behçet (MB), qui peut se présenter comme une tumeur intracardiaque. Sa découverte précède, dans la moitié des cas, le diagnostic de MB. La mortalité élevée peut être en rapport avec des complications post-chirurgicales et/ou une atteinte associée des artères pulmonaires. Nous rapportons l’observation d’un jeune patient de 29 ans, aux antécédents d’aphtose bipolaire, qui a bénéficie d’une intervention chirurgicale après la découverte d’une tumeur de l’atrium et du ventricule droits. Il s’agissait d’un thrombus à l’examen anatomopathologique et dans les suites opératoires nous avons diagnostiqué une MB. L’évolution a été favorable sous traitement médical associant une corticothérapie, de la colchicine et des antivitamines K (AVK). La découverte d’une masse intracardiaque chez un sujet jeune doit faire évoquer le diagnostic de thrombus cardiaque et de maladie de Behçet, même en l’absence de facteur ethnique ou géographique prédisposant.
Collapse
Affiliation(s)
- Fouad Nya
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdessamad Abdou
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mehdi Bamous
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Younes Moutakiallah
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Noureddine Atmani
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Aniss Seghrouchni
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mahdi Ait Houssa
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdellatif Boulahya
- Service de Chirurgie Cardiaque, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| |
Collapse
|
8
|
Eren H, Öcal L, Kalçik M, Efe SÇ, Evlice M, Akçakoyun M. Intracardiac Thrombus in Behçet's Disease. J Cardiovasc Echogr 2016; 26:22-24. [PMID: 28465956 PMCID: PMC5412740 DOI: 10.4103/2211-4122.178472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Behçet's disease (BD) is a chronic multisystem disease that presents with recurrent oral and genital ulceration and recurrent uveitis. The patients are often diagnosed in the range of 20-30 years of age and BD are more common in men.[1] BD has a worldwide distribution, but it is mainly observed in Mediterranean areas and Japan.[2] Involvement of skin, joints, nervous, respiratory, gastrointestinal, and cardiovascular systems is also recognised.[34] Although the vascular lesions are frequently observed in this disease, the cardiac involvement is rare and is associated with the poor prognosis.[5]
Collapse
Affiliation(s)
- Hayati Eren
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Macit Kalçik
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mert Evlice
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Akçakoyun
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Farouk H, Chilali KE, Said K, Sakr B, Salah H, Mahmoud G, Sorour K. Value of certain echocardiographic findings in the initial suspicion of Behçet's disease. Echocardiography 2015; 31:924-30. [PMID: 25208862 DOI: 10.1111/echo.12601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To describe the echocardiographic findings detected as first manifestations of Behçet's disease (BD) and compare these findings with those detected in established cases of BD receiving regular medical treatment. METHODS Two groups of patients were studied. Group 1 comprised 41 patients with BD on regular medical treatment. Group 2 comprised 5 previously healthy patients who presented to the cardiology department because of cardiac symptoms and were diagnosed in retrospect during hospitalization as BD. Thirty-two age- and sex-matched individuals served as control subjects (control group). All patients and controls underwent complete M-mode, two-dimensional, and Doppler transthoracic echocardiographic examinations. RESULTS Of the 41 treated patients with BD (mean age: 32 ± 8 years, 90% males, mean duration since diagnosis: 14.5 years), only 1 patient was found to have severe aortic regurgitation secondary to aortic root dilation. On the other hand, the 5 previously healthy patients who presented with cardiac symptoms (mean age: 24 ± 6 years, all males) had significant cardiac involvement and evident echocardiographic findings (P < 0.001). Four cases had intracardiac masses: 3 in the right atrium (RA), 1 in the right ventricle (RV), while the last patient had pericardial effusion (PE). All these patients were diagnosed in retrospect as BD. The RA masses disappeared on medical therapy, while the RV mass was surgically excised and proved to be multiple thrombi histopathologically. The patient with PE had recurrent attacks of massive effusion so a pericardial window was performed surgically. CONCLUSION Diagnosis of BD might be initially suspected by the cardiologists based on certain echocardiographic findings, namely the presence of right-sided masses. Diagnosis of BD in such patients has important therapeutic implications and accordingly prognostic value.
Collapse
Affiliation(s)
- Heba Farouk
- Cardiovascular Medicine Department, Cairo University Hospital, Cairo, Egypt
| | | | | | | | | | | | | |
Collapse
|
10
|
Demirelli S, Degirmenci H, Inci S, Arisoy A. Cardiac manifestations in Behcet's disease. Intractable Rare Dis Res 2015; 4:70-5. [PMID: 25984424 PMCID: PMC4428189 DOI: 10.5582/irdr.2015.01007] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 11/05/2022] Open
Abstract
Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD.
Collapse
Affiliation(s)
- Selami Demirelli
- Selami Demirelli, M.D, Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
- Address correspondence to: Dr. Selami Demirelli, Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey. E-mail:
| | - Husnu Degirmenci
- Husnu Degirmenci, M.D, Department of Cardiology, Erzincan Universty, Erzincan, Turkey
| | - Sinan Inci
- Sinan Inci, M.D, Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Arif Arisoy
- Arif Arisoy, Department of Cardiology, M.D, Gaziosmanpasa Universty, Medical Faculty, Tokat, Turkey
| |
Collapse
|
11
|
Aksu T, Tufekcioglu O. Intracardiac thrombus in Behçet’s disease: four new cases and a comprehensive literature review. Rheumatol Int 2014; 35:1269-79. [DOI: 10.1007/s00296-014-3174-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
|
12
|
Buturak A, Saygili O, Ulus S, Kalfa M, Karabulut H, Alhan C, Dagdelen S, Aksu K. Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behçet’s disease: case report and review of the literature. Mod Rheumatol 2014; 24:532-6. [DOI: 10.3109/14397595.2013.874731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Xing W, Swaminathan G, Appadorai DR, Sule AA. A rare case of behçet disease presenting with pyrexia of unknown origin, pulmonary embolism, and right ventricular thrombus. Int J Angiol 2014; 22:193-8. [PMID: 24436611 DOI: 10.1055/s-0033-1347906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Behçet disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and uveitis. We describe a rare case of a 43-year-old woman with Behçet disease who was admitted for pyrexia of unknown origin, cough, dyspnea, and chest pain. Her computerized tomography scan revealed pulmonary embolism and right ventricular thrombus. She was treated with anticoagulation for pulmonary embolism and right ventricular thrombus. She was well during her last follow-up.
Collapse
Affiliation(s)
- Weili Xing
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Girider Swaminathan
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Dorai Raj Appadorai
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Ashish Anil Sule
- Department of General Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| |
Collapse
|
14
|
Desbois AC, Wechsler B, Cluzel P, Helft G, Boutin D, Piette JC, Cacoub P, Saadoun D. [Cardiovascular involvement in Behçet's disease]. Rev Med Interne 2014; 35:103-11. [PMID: 24434015 DOI: 10.1016/j.revmed.2013.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/02/2013] [Indexed: 12/15/2022]
Abstract
Vascular involvement is a common complication of Behçet's disease (BD) and affects up to 40% of BD patients. These complications worsen the prognosis of BD. The concept of vasculo-Behçet has been adopted for cases in which vascular complications dominate the clinical features. Vascular manifestations affect particularly young men, during the first years following onset of the disease. Venous complications are the most frequent vascular complications, affecting 14 to 40% of BD patients. Superficial and deep lower limb thrombosis is the most frequent venous complications but one third of venous thrombosis concern large vessels (such as cerebral venous thrombosis, pulmonary embolism, and inferior or superior vena cava, etc.). Budd-Chiari syndrome is the worst prognostic factor increasing mortality by 9 times. Arterial complications (2 to 17% of BD patients) include aneurysms and occlusions/stenosis. Main locations of arterial lesions are aortic (abdominal and thoracic), femoral, pulmonary and iliac arteries. Aneurysms are the most severe arterial complications, particularly pulmonary aneurysms associated with a high risk of massive bleeding. Cardiac complications (up to 6% of BD patients) include pericarditis, endocardial lesions (aortic regurgitation and less often mitral insufficiency), myocardial lesions (myocardial infarction, myocarditis and endomyocardial fibrosis) and intracardiac thrombosis (right ventricle and atrium). Coronary lesions complicated to myocardial infarction are the most severe cardiac complications. Treatment is based on corticosteroids and immunosuppressive drugs. The use of anticoagulation in venous thrombosis is still controversial.
Collapse
Affiliation(s)
- A-C Desbois
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France
| | - B Wechsler
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - P Cluzel
- Service de radiologie, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - G Helft
- Service de cardiologie, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - D Boutin
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - J-C Piette
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - P Cacoub
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France
| | - D Saadoun
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France.
| |
Collapse
|
15
|
Bouzelmat H, Chaib A, Kheyi J, Kotni M, Ghafir D, Moustaghfir A. [Hemoptysis revealing pulmonary artery aneurysm associated with intracardiac thrombosis: a delicate anticoagulation situation (a case report of Behçet's disease)]. ACTA ACUST UNITED AC 2013; 38:198-200. [PMID: 23410873 DOI: 10.1016/j.jmv.2013.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
Abstract
Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic challenge. We report the case of a 26-year-old patient hospitalized for moderately abundant hemoptysis and New York Heart Association (NYHA) class III dyspnea, which illustrates the difficulty encountered when using anticoagulants in this complex situation.
Collapse
Affiliation(s)
- H Bouzelmat
- Service de Cardiologie, Hôpital Militaire d'Instruction Mohammed V, 10000 Rabat, Maroc.
| | | | | | | | | | | |
Collapse
|
16
|
Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behçet’s disease: case report and review of the literature. Mod Rheumatol 2012. [DOI: 10.1007/s10165-012-0801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
17
|
Zaghba N, Ech-cherrate A, Benjelloun H, Yassine N, Bakhatar A, Bahlaoui A. [Cardiac thrombosis, pulmonary artery aneurism and pulmonary embolism revealed Behçet's disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:307-310. [PMID: 22749620 DOI: 10.1016/j.pneumo.2012.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 04/21/2012] [Accepted: 04/23/2012] [Indexed: 06/01/2023]
Abstract
Intracardiac thrombosis is a rare complication of Behçet's disease. It may be isolated or associated with arterial disease. We report a case of a patient from northern Morocco, aged 23, without specific medical history. He consulted for recurrent hemoptysis of middle abundance, associated with bipolar aphthosis. Chest radiography showed a left basal opacity fuzzy and right paracardiac opacity. The thoracic CT objectified left segmental lower lobe embolism, an aneurysm of a segmental branch of the right lower lobe and right intraventricular thrombus. Echocardiography confirmed the intracardiac thrombus. The patient was treated by oral corticosteroids, azathioprine, colchicine, and anticoagulants. The outcome was favorable with complete resolution of intraventricular thrombus and the aneurysm.
Collapse
Affiliation(s)
- N Zaghba
- Service des Maladies Respiratoires, CHU Ibn Rochd, Casablanca, Maroc.
| | | | | | | | | | | |
Collapse
|
18
|
Bouomrani S, Farah A, Bouassida N, Ayadi N, Béji M. Pseudotumeur inflammatoire de l’orbite associée à une névrite optique au cours d’une maladie de Behçet. J Fr Ophtalmol 2012; 35:439.e1-6. [DOI: 10.1016/j.jfo.2011.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/05/2011] [Accepted: 08/23/2011] [Indexed: 10/28/2022]
|
19
|
Geri G, Wechsler B, Thi Huong DL, Isnard R, Piette JC, Amoura Z, Resche-Rigon M, Cacoub P, Saadoun D. Spectrum of cardiac lesions in Behçet disease: a series of 52 patients and review of the literature. Medicine (Baltimore) 2012; 91:25-34. [PMID: 22198500 DOI: 10.1097/md.0b013e3182428f49] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiac abnormalities in patients with Behçet disease (BD) include pericarditis, myocarditis, endocarditis with valvular regurgitation, intracardiac thrombosis, endomyocardial fibrosis, coronary arteritis with or without myocardial infarction, and aneurysms of the coronary arteries or sinus of Valsalva. Data regarding the clinical spectrum, prevalence, and outcome of cardiac lesions in BD are lacking. In this study, we report the main characteristics, treatment, and long-term outcomes of 52 patients with cardiac lesions from a cohort of 807 (6%) BD patients. Forty-five (86.5%) patients were male, with a mean (±SD) age at BD diagnosis of 29.3 ± 10.3 years.Cardiac involvement was the first feature of BD in 17 (32.7%) patients. Cardiac lesions included pericarditis (n = 20; 38.5%), endocarditis (mostly aortic insufficiency) (n = 14; 26.9%), intracardiac thrombosis (n = 10; 19.2%), myocardial infarction (n = 9; 17.3%), endomyocardial fibrosis (n = 4; 7.7%) and myocardial aneurysm (n = 1; 1.9%). Patients with cardiac involvement were more frequently male (86.5% vs. 64.9%; p < 0.01) and had more arterial (42.3% vs. 11.1%; p < 0.01) and venous lesions (59.6% vs. 35.8%; p < 0.01) compared to those without cardiac manifestations. Factors associated with complete remission of cardiac involvement were treatment regimens with oral anticoagulants, immunosuppressants, and colchicine. The 5-year survival rate was 83.6% and 95.8% (p = 0.03) in BD patients with and without cardiac involvement, respectively. After a median (Q1-Q3) follow-up of 3.0 (1.75-4.2) years, 8 patients had died, in 3 cases directly related to cardiac involvement.In conclusion, cardiac lesions affected 6% of our large cohort of BD patients. The prognosis of cardiac involvement in BD is poor and improves with oral anticoagulation, immunosuppressive therapy, and colchicine.
Collapse
Affiliation(s)
- Guillaume Geri
- From Service de Médecine Interne 2 (GG, BW, DLTH, JCP, ZA, PC, DS) and Service de Cardiologie (RI), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris; Laboratory I3 "Immunology, Immunopathology, Immunotherapy" (GG, PC, DS), UMR 7211 (CNRS/UPMC) INSERM U959, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris 6; and Département de Biostatistique (MRR), Groupe Hospitalier Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Khammar Z, Berrady R, Boukhrissa A, Lamchachti L, Amrani K, Rabhi S, Bono W. Thrombose intracardiaque au cours de la maladie de Behçet : étude de trois observations. ACTA ACUST UNITED AC 2011; 36:270-3. [DOI: 10.1016/j.jmv.2011.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/29/2011] [Indexed: 11/16/2022]
|
21
|
Sezen Y, Buyukhatipoglu H, Buyukatipoglu H, Kucukdurmaz Z, Geyik R. Cardiovascular involvement in Behçet's disease. Clin Rheumatol 2009; 29:7-12. [PMID: 19830382 DOI: 10.1007/s10067-009-1302-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 10/05/2009] [Indexed: 12/16/2022]
Abstract
Behçet's disease is a chronic relapsing systemic vasculitis that can involve almost every organ and systems in the body with extremely different diverse manifestations. Cardiovascular involvement is one of these manifestations, the involvement of which might present in various patterns in itself. Cardiovascular involvement is relatively uncommon in Behçet's disease; however, Behçet's disease is relatively rather common in certain parts of the world. Therefore, especially in these locations recognizing such miscellaneous presentations are of critical importance, since cardiovascular involvements exceed other presentation in mortality and morbidity rates. Based on these facts, in this review, we summarized the cardiovascular involvements and its different manifestations in Behçet's disease.
Collapse
Affiliation(s)
- Yusuf Sezen
- Department of Internal Medicine, Harran University School of Medicine, Sanliurfa, Turkey
| | | | | | | | | |
Collapse
|
22
|
Myocardial Inflammatory Pseudotumor and Multiple Thromboses as a Manifestation of Behcet Disease. J Clin Rheumatol 2009; 15:252-3. [DOI: 10.1097/rhu.0b013e3181b082a0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Marc K, Iraqui G, Jniene A, Benamor J, Bourkadi JE. Thrombose intracardiaque et anévrysmes de l’artère pulmonaire au cours de la maladie de Behçet. Rev Mal Respir 2008; 25:69-72. [PMID: 18288054 DOI: 10.1016/s0761-8425(08)70469-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Marc
- Service de Pneumologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Morocco.
| | | | | | | | | |
Collapse
|
24
|
Kajiya T, Anan R, Kameko M, Mizukami N, Minagoe S, Hamasaki S, Maruyama I, Sakata R, Tei C. Intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism in a patient with Behçet's disease: a case report and literature review. Heart Vessels 2007; 22:278-83. [PMID: 17653524 DOI: 10.1007/s00380-006-0973-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 12/22/2006] [Indexed: 11/28/2022]
Abstract
A 26-year-old woman with intermittent fever was admitted to our hospital, and gradually developed facial edema. Examinations including computed tomography, transesophageal echocardiography, digital subtraction angiography, and pulmonary perfusion scintigraphy revealed intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism. Clinical findings and laboratory data led us to make a diagnosis of Behçet's disease. Combination of intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism are rare complications in Behçet's disease. Behçet's disease should be considered in the differential diagnosis of intracardiac mass of the right heart, and early diagnosis and treatment are essential for the management of Behçet's disease especially with large-vessel manifestations. In addition to a case report, we review the literature and report the characteristics of intracardiac thrombus in Behçet's disease.
Collapse
Affiliation(s)
- Takashi Kajiya
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|