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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.
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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
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2
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Nagafuchi H, Kikuchi H, Ishibash H, Maeda H, Ogino H, Kirino Y, Sawada T, Saito K, Kuwana M, Hirohata S, Ishigatsubo Y, Niimi M, Okita Y, Miyata T, Shigematsu H, Takeno M. Recommendations for the management of the vascular involvement in Behçet's disease by the Japanese National Research Committee for Behçet's disease-secondary publication. Mod Rheumatol 2023; 34:182-193. [PMID: 36658731 DOI: 10.1093/mr/road002] [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] [Received: 09/22/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to develop clinical guidelines for the management of vascular Behçet's disease (BD) by the Behçet's Disease Research Committee of the Ministry of Health, Labour and Welfare of the Japanese Government. METHODS A task force proposed clinical questions (CQs) concerning vascular BD based on a literature search. After screening, draft recommendations were developed for each CQ and brushed up in three blinded Delphi rounds, leading to the final recommendations. RESULTS This study provides recommendations for 17 CQs concerning diagnosis and differential diagnoses, assessment of disease activity, and treatment. The guidelines recommend immunosuppressive treatments, for both arterial and venous involvement with active inflammation. Anticoagulation is also recommended for deep vein thrombosis except in high-risk patients. Surgical and endovascular therapies can be optional, particularly in patients with urgent arterial lesions undergoing immunosuppression. In addition, two sets of algorithms for diagnosis and treatment are shown for arterial and venous involvement. CONCLUSIONS These recommendations are expected to serve as useful tools in the daily clinical practice of BD. This content has already been published in Japanese in the Guideline for the Management of Behçet's Disease 2020 and is submitted with permission from both the primary and secondary publishers.
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Affiliation(s)
- Hiroko Nagafuchi
- Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotoshi Kikuchi
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan
| | - Hiroyuki Ishibash
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hideaki Maeda
- Department of Cardiovascular Center, Ukima Central Hospital, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazuyoshi Saito
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Shunsei Hirohata
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Tetsuro Miyata
- Office of Medical Education, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare, Narita, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
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3
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Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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4
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Mousa A, Abdelmohsen AA, Nasr MA, Zakaria MY, Sharabi SA, El Kasaby MI, Abd El Hamid AA, Abdul Hakim S, Nassar AK, El Azzazy M, Elkalla MA, Sharabi A. Adjunctive proximal aortic and aortodistal prosthetic wrapping of vascular anastomoses for Adamantiadis-Behçet's aortic/aortoiliac aneurysms: A revisit. Asian J Surg 2023; 46:483-491. [PMID: 35750611 DOI: 10.1016/j.asjsur.2022.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We described our local experiences with a single-layer wrapping technique for the vascular anastomoses in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms using InterGard Silver-impregnated Dacron® patch prosthesis. METHODS Between January 2013 to December 2019, we retrospectively reviewed 20 patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. All patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. Two groups were analyzed, Group I, considered as a control group (n = 20). While group II (n = 20), of which prosthetic wrapping was performed. Follow up took place for a maximum of 24 months. RESULTS during a six-year retrospective study period, 20 patients were recruited. They included 15 males and five females (ratio 3:1). The median age was 30.5 ± 4.2 years. Anastomotic pseudoaneurysms were reported in group I (control, [non-wrapping group]). While group II doesn't (wrapping group). Paired samples t test revealed a significant difference between those underwent wrapping and those with non-wrapping (p = .019 and .038). False aneurysms were reported in 80% of the non-wrapping group as estimated by the Kaplan-Meier curves. While Log-rank test results revealed a significant difference between both the studied groups (p < .008). Primary graft patency was 90% at 24 months as reported by the Kaplan-Meier survival method. CONCLUSIONS adjunctive wrapping for vascular anastomoses using Intergard Silver-impregnated Dacron® patch in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms is an applicable, simple, and reliable technique. It was associated with low morbidity and mortality rates. Moreover, we discussed a relatively old technique aiming to explore its success and safety in treating arterial aneurysms in Adamantiadis-Behçet's disease patients.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt.
| | - Abdelhalim A Abdelmohsen
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed A Nasr
- Department of Vascular Surgery and Endovascular Therapy, Assuit University Hospital, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt
| | - Mohamed Y Zakaria
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Sherif A Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed I El Kasaby
- Department of Ophthalmology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Aida A Abd El Hamid
- Department of Clinical Pathology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Sami Abdul Hakim
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Abdelfattah K Nassar
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed El Azzazy
- Department of Diagnostic and Interventional Radiology, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mai A Elkalla
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
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Giannessi C, Smorchkova O, Cozzi D, Zantonelli G, Bertelli E, Moroni C, Cavigli E, Miele V. Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:2868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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Affiliation(s)
| | | | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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Jalali KS, Alhazzaa MA, Alqahtani S, Alattas MY. Pontine Infarction and Vertebral Artery Dissecting Aneurysm as the First Presentation of Behçet's Disease: A Case Report. Cureus 2022; 14:e29204. [PMID: 36259031 PMCID: PMC9572958 DOI: 10.7759/cureus.29204] [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] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Behçet's disease (BD) is a systemic disease of inflammatory origin that appears most often in the third or fourth decade of life. Behçet's disease is hallmarked predominantly by mucocutaneous lesions and ocular involvement. Vertebral artery dissection and neurological manifestations are rare complications in Behçet's disease. We examine the case of a medically free 33-year-old male who was admitted to the emergency department complaining of sudden-onset dizziness, vomiting, and tinnitus. Neurological examination revealed fluctuating consciousness, multiple gaze nystagmus, motor deficit in the upper and lower limbs, bilateral Babinski sign, and truncal ataxia. Magnetic resonance imaging (MRI) showed a right pontine hyperintense lesion on T2-weighted images (T2WI). A right vertebral angiogram four months after the incident showed a dissection in the mid-cervical third of an anomalous duplicated origin arm of the right vertebral artery. This case describes an uncommon form of initial presentation of Behçet's disease via a pontine infarction triggered by a dissecting aneurysm in an anatomically rare variant of the vertebral artery.
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Affiliation(s)
- Kafaf S Jalali
- Internal Medicine, Prince Mohammed Bin Abdulaziz Hospital/Saudi Commission for Health Specialties, Medina, SAU
| | | | - Sultan Alqahtani
- Interventional Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, SAU
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7
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Chuang KW, Chang HC. Risk of ischaemic heart diseases and stroke in behçet disease: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13778. [PMID: 35342952 DOI: 10.1111/eci.13778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet disease (BD) is a systemic vasculitis. In addition to the mucocutaneous lesions, the vascular injury of pathophysiology in BD is theoretically correlated with cardiovascular diseases. This study aimed to elucidate the association of BD with ischaemic heart diseases (IHDs) and stroke. METHODS A systematic search of PubMed, Embase, Web of Science and Cochrane Library databases was performed for all relevant observational studies from database inception until 10 July 2021. No language restriction was applied. A random-effects model was used for meta-analysis. RESULTS A total of six observational studies consisting of three cohort studies, two cross-sectional studies and one study with both study designs were adopted in the meta-analysis. The numbers of patients with BD and healthy controls were 9,813 and 41,802, respectively. The pooled analysis demonstrated no significant association between BD and IHD. By contrast, we found that patients with BD had a significantly higher risk of stroke (adjusted hazard ratio, 2.083; 95% confidence interval, 1.339-3.240; p = 0.001) than healthy controls. We observed substantial heterogeneity across studies in few meta-analyses, but no significant publication bias was detected in any of the meta-analyses. CONCLUSIONS BD was significantly associated with stroke but not IHD. Physicians should be aware of possible vascular and neurological complications during care of patients with BD.
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Affiliation(s)
- Kai-Wen Chuang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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8
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Emara MM, Mahmoud MM, Saad MN, Mabrouk MS, Hamed M, Shaker OG. An association study between FokI, BsmI, miR-146a, and miR-155 and Behcet’s disease in the Egyptian population. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2021. [DOI: 10.1186/s43042-021-00166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Behcet’s disease (BD) is a systemic inflammatory disease of the blood vessels and affects various body parts. This study aimed to determine the association of four single-nucleotide polymorphisms (SNPs) and BD in the Egyptian population using multiple statistical models and show the resulting associations along with previous studies of different populations. Four SNPs were examined for their association with BD: two SNPs from vitamin D receptor gene (FokI and BsmI) were selected and the other two were selected from miR-146a and miR-155. These four SNPs were selected for their association and role with BD in different populations and in the immune system. A marker check was conducted using the Hardy-Weinberg equilibrium and minor allele frequency. The associations were tested using four different statistical models: multiplicative, dominant, recessive, and codominant models. All statistical models used the odd’s ratio (OR) with confidence interval (CI) of 95% to evaluate the association of each SNP.
Results
BsmI showed association using the four models, while FokI did not show any association through any model. miR-155 showed association using the multiplicative and recessive models. miR-146a showed association using the multiplicative model only.
Conclusions
As a result, BsmI, miR-155, and miR-146a SNPs could have a role in the development of BD in the Egyptian population, while FokI could have a weak role, if any, in the development of BD in the Egyptian population.
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9
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Thoracic Complications in Behçet's Disease: Imaging Findings. Can Respir J 2020; 2020:4649081. [PMID: 32566055 PMCID: PMC7275231 DOI: 10.1155/2020/4649081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.
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Lin CH, Luo D, Ma HF, Shen Y, Zou J, Guan JL. Clinical characteristics and factors influencing the prognosis of Behçet’s disease complicated with vascular involvement. VASA 2020; 49:309-318. [PMID: 32228221 DOI: 10.1024/0301-1526/a000859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Summary: Background: Vascular Behçet's disease (VBD) might involve all sizes of arterial and venous vessels. Major vascular involvement caused the primary death in Behçet's syndrome (BS). We aimed to investigate the clinical characteristics and factors influencing the prognosis of VBD. Patients and methods: A retrospective analysis of the prospectively collected data of the Shanghai BS database from October 2012 to October 2018 was conducted. Patients who were diagnosed with BS and merged with venous thrombosis, arterial aneurysms, and arterial stenosis/occlusions were enrolled. Results: There were 47 patients with vascular involvement among 836 BS patients, 38 males and 9 females. The numbers of patients with venous thrombosis, arterial aneurysm, and arterial stenosis/occlusion were 25 (53.2 %), 21 (44.7 %), and 12 (25.5 %), respectively. Nearly half of the venous thromboses were located in limbs (n = 22, 46.8 %). Arterial aneurysm was the main form of arterial lesion. Most of the patients (93.6 %) were treated with corticosteroids and immunosuppressants. Late onset of BS or with arterial involvement had lower treatment response. Therapy with biological agents had significantly better results than that in the group without biological treatment (94.1 % vs. 80 %, P = 0.005). Conclusions: VBD showed a male preponderance and more than half of the patients presented with venous thrombosis. Late onset and arterial involvement were associated with poor prognosis. Therapy with biological agents is a viable alternative treatment to improve the prognosis.
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Affiliation(s)
- Chen-Hong Lin
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Hai-Fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
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Choi SJ, Koo HJ, Yang DH, Kang JW, Oh JS, Hong S, Kim YG, Yoo B, Lee CK. Comparison of Clinical, Angiographic Features and Outcome in Takayasu's Arteritis and Behçet's Disease With Arterial Involvement. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.2.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Su Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Elrobaa I, Elserhy M, Ahmad M, Subidar M, Alhadi H. Al Wakra emergency presentation of Behcet's disease. AME Case Rep 2019; 3:34. [PMID: 31616862 DOI: 10.21037/acr.2019.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022]
Abstract
This is atypical presentation of Behcet's disease and it's important for emergency physician and doctors who are working in acute medicine. We reported a case of a young patient presenting back pain concerning the right leg, a result of extensive bilateral deep vein thrombosis (DVT) in both legs that extended to inferior vena cava (IVC) and renal veins. After a bundle of investigations and medical examinations, the case was diagnosed as Behcet's disease with an atypical presentation. Al Wakra emergency presentation of Behcet's disease: low back pain with lower limb pain that result of DVT which is one of vascular complication of Behcet's disease.
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Affiliation(s)
- Islam Elrobaa
- Al Wakra Emergency Department, Al Wakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar
| | - Mohamed Elserhy
- Al Wakra Emergency Department, Al Wakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar
| | - Muayad Ahmad
- Al Wakra Emergency Department, Al Wakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar
| | - Mohamed Subidar
- Al Wakra Emergency Department, Al Wakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar
| | - Hassan Alhadi
- Al Wakra Emergency Department, Al Wakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar
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Attia DHS, Abdel Noor RA, Salah S. Shedding light on vasculitis in Egypt: a multicenter retrospective cohort study of characteristics, management, and outcome. Clin Rheumatol 2019; 38:1675-1684. [PMID: 30737592 DOI: 10.1007/s10067-019-04441-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The frequency of different vasculitides and their characteristics vary among different regions. The identification of geographic disparities of disease phenotypes helps the development of international criteria, allowing the classification of patients of different ethnicities. This study aimed to describe the frequency, characteristics, course, response to treatment, and outcome of the different adulthood vasculitides in Egypt. METHODS This was a multicenter study in which the medical records of adult Egyptian patients diagnosed with vasculitis between 2002 and 2018 were retrospectively reviewed. RESULTS The most frequent vasculitides in Egypt were Behçet's disease (76%), hepatitis C virus vasculitis (13.9%), and granulomatosis with polyangiitis (3.9%). Most patients (73.8%) had a major event at the time of diagnosis. Generalized granulomatosis with polyangiitis was more common than the localized type (90% versus 10%, respectively). The aortic arch and its branches were the most common affected sites of Takayasu arteritis. Of vasculitides, Behçet's disease and giant cell arteritis were associated with the greatest rates of relapse (62.7% and 33.3%, respectively). Delayed diagnosis and permanent organ damage were reported in 69.9% and 68.9% of patients, respectively. A low mortality rate was noted (1.3%). CONCLUSIONS The most common types of adulthood vasculitides in Egypt are Behçet's disease, hepatitis C virus vasculitis, and granulomatosis with polyangiitis. Major organ involvement is frequent. Delayed diagnosis and permanent organ damage are common.
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Affiliation(s)
- Doaa Hassan Sayed Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University Hospitals, Saray El Manial Street, El Manial, Cairo, 11956, Egypt.
| | - Rasha A Abdel Noor
- Internal Medicine and Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shaimaa Salah
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Abstract
Behçet syndrome is considered to be a multisystemic vasculitis involving the skin, mucosa, eyes, joints, nervous system, cardiovascular system, and gastrointestinal system. The exact pathogenesis of the disease is unknown, but autoimmune factors are thought to play the main role. Vasculitis in Behçet syndrome can involve any kind and size of vessels, and this explains why the disease has the ability of multisystemic involvement. The commonest clinical presentation of Behçet syndrome is recurrent and painful mucocutaneous ulcerations known as aphthosis. The other clinical manifestations vary among patients and populations. The disease tends to be more severe in men. Ocular, vascular, and central nervous system involvements are the major causes of morbidity and mortality. Behçet syndrome is a mimicker of many diseases with its several faces and considered as one of the great imitators in dermatology.
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Affiliation(s)
- Necmettin Akdeniz
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey.
| | - Ayşe Serap Karadağ
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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15
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Kim JH, Lee KA, Jung MY, Kim AR, Yoon JM, Shim HJ, Lee SH, Kim HY, Kim HR. Pulmonary thromboembolism in patient with coexistence of Behçet's disease and antiphospholipid syndrome. Int J Rheum Dis 2018; 21:2188-2192. [DOI: 10.1111/1756-185x.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jun-Hyun Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Kyung-Ann Lee
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Min-Young Jung
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Ah-Ran Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Jeong-Min Yoon
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Hyoung-Joon Shim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Sang-Heon Lee
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
- Division of Rheumatology; Department of Internal Medicine; Konkuk University School of Medicine; Seoul Korea
| | - Ho-Youn Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Hae-Rim Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
- Division of Rheumatology; Department of Internal Medicine; Konkuk University School of Medicine; Seoul Korea
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16
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Kilian NC, Sawalha AH. Behçet's disease in the United States: A single center descriptive and comparative study. Eur J Rheumatol 2017; 4:239-244. [PMID: 29308276 DOI: 10.5152/eurjrheum.2017.17112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Behçet's disease is heterogeneous with clinical variability across ethnicities and geographic locations. The goal of this study was to analyze the clinical characteristics of our multi-ethnic Behçet's disease cohort at the University of Michigan. Material and Methods A detailed patient characterization was performed. Differences in disease characteristics between men and women, and between patients fulfilling the International Criteria for Behçet's Disease (ICBD) and the International Study Group criteria (ISG) were determined in our cohort. Results A total of 114 patients with a male to female ratio of ~ 1:4 were included. All patients met the ICBD criteria, including 76 who also met the ISG criteria. Over 95% of patients had recurrent genital ulcers, which is higher than generally reported. Retinitis was 5.3 times more likely in men than in women (p=0.009), and arthralgia was 3.3 times more likely in women than men (p=0.048). When comparing cohorts derived from the two different criteria, the ISG cohort had more skin manifestations (OR=3.3, p=0.0006). Acneiform lesions were associated with ~8 times higher odds of developing retinitis in our patients (p=0.0008), and superficial thrombophlebitis was associated with a trend for higher odds of developing uveitis (OR=4.1, p=0.057). Using the ICBD criteria, 38 additional patients were identified compared to only using the ISG criteria. Of these patients, 28 presented with only mucosal ulceration with or without joint involvement. Conclusion We characterize Behçet's disease in a multi-ethnic cohort from North America. Using ICBD criteria in the United States significantly increases the likelihood of identifying Behçet's disease, particularly in patients with isolated mucosal involvement who constitute a substantial subset of patients in this region.
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Affiliation(s)
- Nathan C Kilian
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amr H Sawalha
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
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17
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Khan E, Ambrose NL, Ahnström J, Kiprianos AP, Stanford MR, Eleftheriou D, Brogan PA, Mason JC, Johns M, Laffan MA, Haskard DO. A low balance between microparticles expressing tissue factor pathway inhibitor and tissue factor is associated with thrombosis in Behçet's Syndrome. Sci Rep 2016; 6:38104. [PMID: 27924945 PMCID: PMC5141484 DOI: 10.1038/srep38104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022] Open
Abstract
Thrombosis is common in Behçet's Syndrome (BS), and there is a need for better biomarkers for risk assessment. As microparticles expressing Tissue Factor (TF) can contribute to thrombosis in preclinical models, we investigated whether plasma microparticles expressing Tissue Factor (TF) are increased in BS. We compared blood plasma from 72 healthy controls with that from 88 BS patients (21 with a history of thrombosis (Th+) and 67 without (Th-). Using flow cytometry, we found that the total plasma MP numbers were increased in BS compared to HC, as were MPs expressing TF and Tissue Factor Pathway Inhibitor (TFPI) (all p < 0.0001). Amongst BS patients, the Th+ group had increased total and TF positive MP numbers (both p ≤ 0.0002) compared to the Th- group, but had a lower proportion of TFPI positive MPs (p < 0.05). Consequently, the ratio of TFPI positive to TF positive MP counts (TFPI/TF) was significantly lower in Th+ versus Th- BS patients (p = 0.0002), and no patient with a TFPI/TF MP ratio >0.7 had a history of clinical thrombosis. We conclude that TF-expressing MP are increased in BS and that an imbalance between microparticulate TF and TFPI may predispose to thrombosis.
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Affiliation(s)
- E Khan
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - N L Ambrose
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - J Ahnström
- Centre for Haematology, Department of Medicine, Imperial College, London, UK
| | - A P Kiprianos
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M R Stanford
- Department of Ophthalmology, King's College, London, UK
| | - D Eleftheriou
- Institute of Child Heath, University College, London, UK
| | - P A Brogan
- Institute of Child Heath, University College, London, UK
| | - J C Mason
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M Johns
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M A Laffan
- Centre for Haematology, Department of Medicine, Imperial College, London, UK
| | - D O Haskard
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
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18
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Lo Gullo A, Koster MJ, Crowson CS, Makol A, Ytterberg SR, Saitta A, Salvarani C, Matteson EL, Warrington KJ. Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study. PLoS One 2016; 11:e0149579. [PMID: 26901431 PMCID: PMC4763510 DOI: 10.1371/journal.pone.0149579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/01/2016] [Indexed: 01/06/2023] Open
Abstract
Objective To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. Methods A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. Results The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. Conclusion In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina ME, Italy
| | - Matthew J. Koster
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- * E-mail:
| | - Cynthia S. Crowson
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- Department of Health Sciences Research, Division of Biomedical Statistics, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Ashima Makol
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Steven R. Ytterberg
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Antonino Saitta
- Department of Clinical and Experimental Medicine, University of Messina, Messina ME, Italy
| | - Carlo Salvarani
- Department of Internal Medicine, Rheumatology Unit, Azienda Ospedaliera ASMN, Reggio Emilia, Italy
| | - Eric L. Matteson
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Kenneth J. Warrington
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
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Merashli M, Ster IC, Ames PRJ. Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis. Semin Arthritis Rheum 2016; 45:502-10. [DOI: 10.1016/j.semarthrit.2015.06.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/23/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
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20
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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]
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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
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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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22
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Detanico AB, Brandão ML, Fernandes LDF, Camelo CPR, Santos JRSD. Aortic thrombosis in a patient with a late diagnosis of Behcet's disease. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease is form of systemic vasculitis of unknown etiology. One surprising feature is that arterial involvement is less common in this disease than venous forms, accounting for 1 to 7% of patients. In 7 to 30% of cases the vascular symptoms precede the clinical diagnosis of Behcet. We describe the case of a patient with Thromboangiitis Obliterans who was treated with lumbar sympathectomy and an aortobiiliac bypass. Around 1 year later he was diagnosed with Behcet's disease after presenting with oral ulcers, genital ulcers and scaling lesions on the hands.
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23
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Kim SR, Leem DW, Moon IJ, Koh BS, Chang MH, Yoo J, Yang HC, Lee CH. A Case of Azathioprine Induced Warfarin Resistance in Behçet's Disease. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sung Ryeol Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Woo Leem
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Il Joo Moon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Koh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hee Chang
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hee Chul Yang
- Department of Diagnostic Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chan Hee Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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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]
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25
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Bonitsis NG, Luong Nguyen LB, LaValley MP, Papoutsis N, Altenburg A, Kötter I, Micheli C, Maldini C, Mahr A, Zouboulis CC. Gender-specific differences in Adamantiades-Behçet's disease manifestations: an analysis of the German registry and meta-analysis of data from the literature. Rheumatology (Oxford) 2014; 54:121-33. [PMID: 25118314 DOI: 10.1093/rheumatology/keu247] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We investigated the effect of gender on the clinical Adamantiades-Behçet's disease (ABD) phenotype with data from the German ABD registry and a meta-analysis from a systematic literature review. METHODS Using the German ABD registry data, we compared 36 clinical variables by gender (with women as the reference category) and investigated potential effect modification by HLA-B5 or ethnic background. The registry data were combined with those from a literature search to calculate pooled relative risks (RRs) for variables with data from ≥10 relevant datasets. RESULTS The German ABD registry provided information for 747 subjects (58.1% males) and the systematic literature review identified another 52 datasets informing on 16 variables. Both analyses consistently revealed the association of male gender with ocular involvement (RR 1.28 and 1.34 from the ABD registry and meta-analysis, respectively), folliculitis (RR 1.30 and 1.26), papulopustular lesions (RR 1.23 and 1.25), vascular involvement (RR 2.31 and 2.27), superficial (RR 2.96 and 1.63) and deep venous thromboses (RR 2.56 and 2.16) and female gender with genital ulcers (RR 0.78 and 0.92) and joint involvement (RR 0.79 and 0.89). The ABD registry data additionally showed male gender associated with heart involvement (RR 10.60), whereas the meta-analyses revealed male gender associated with the pathergy test (RR 1.14) and female gender associated with erythema nodosum (RR 0.86). HLA-B5 and Turkish or German origin did not affect the observed associations. CONCLUSION These analyses support gender-associated clinical variations in ABD and in particular a clinically meaningful risk of cardiovascular involvement for men.
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Affiliation(s)
- Nikolaos G Bonitsis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Liem B Luong Nguyen
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Michael P LaValley
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Nestor Papoutsis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Ina Kötter
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Christiana Micheli
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Carla Maldini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Alfred Mahr
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, German Registry of Adamantiades-Behçet's Disease, Dessau, Germany, Department of Internal Medicine, Hospital Saint-Louis, Paris, France, Department for Statistics, School of Public Health, Boston University, Boston, MA, USA and ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France.
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Alkaabi JK, Gravell D, Al-Haddabi H, Pathare A. Haemostatic Parameters in Patients with Behçet's Disease. Sultan Qaboos Univ Med J 2014; 14:e190-e196. [PMID: 24790741 PMCID: PMC3997535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/11/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the cause of thrombosis in Behçet's disease (BD) patients, since abnormalities in coagulation and fibrinolytic parameters have shown contradictory results. METHODS Haemostatic parameters were retrospectively evaluated in BD patients treated between January 2007 and January 2011 at Sultan Qaboos University Hospital, Oman. The blood samples of 35 Omani BD patients and 30 healthy controls were analysed for factor VIII:C levels, activated protein C resistance (APCR), von Willebrand factor (vWF) antigens (Ag), collagen binding and ristocetin co-factor activity (RiCoF), antithrombin (AT), protein C (chromogenic and clotting), protein S, homocysteine, tissue plasminogen activator, plasminogen activator inhibitor, plasminogen, alpha 2-antiplasmin, lupus anticoagulant and anticardiolipin and beta2-glycoprotein-1 antibodies. RESULTS The mean values of factor VIII:C, vWF Ag, AT and protein S were significantly higher in the patient group (P = 0.01, 0.006, 0.04 and 0.01, respectively). There was no deficiency in protein C. Screening for APCR, anticardiolipin antibodies, anti-beta2-glycoprotein-1 antibodies and lupus anticoagulant was negative and there were no differences in homocysteine levels, nor were there differences between patients with and without thrombosis. Six patients had elevated factor VIII:C levels (>150 IU/dL, P <0.02) which normalised on repeat measurements after three months. CONCLUSION The elevation of factors VIII:C, vWF Ag and AT most likely represent an acute phase phenomenon. In this study, thrombophilic factors did not seem to explain thrombotic tendency. Therefore, further mechanistic studies in a larger group of patients are needed to elucidate the basis for thrombosis in BD. We hypothesise that active BD causes vasculitic endothelial perturbation with dysfunction, leading to the observed increased propensity for thrombosis.
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Affiliation(s)
- Juma K. Alkaabi
- Rheumatology Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - David Gravell
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamood Al-Haddabi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
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Fioramonti P, Fino P, Ponzo I, Ruggieri M, Onesti MG. Intense pulsed light in the treatment of telangiectasias: case report of Behçet's disease with superficial vascular involvement. J COSMET LASER THER 2013; 16:124-8. [PMID: 24131092 DOI: 10.3109/14764172.2013.854634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Behçet's disease (BD) is a chronic systemic inflammatory disorder of unknown etiology with variable clinical manifestations. HLA-B51 allele is the most strongly associated known genetic factor. The mucocutaneous lesions (oral aphthae, genital aphthae, skin lesions such as pseudofolliculitis) constitute the hallmark of the disease, but also gastrointestinal, vascular, central nervous systems, and others may be involved. We report a case of a young man affected with Behçet's disease who presented facial telangiectasias and striae rubra in the inner region of his arms and at the level of his hips, as uncommon minor superficial vascular manifestations of BD. To manage them we have subjected the patient to a cycle of Intense Pulsed Light (IPL) therapy. Our findings showed that the use of IPL is a safe and effective treatment for telangiectasias and striae rubra, also in the complex clinical condition of Behçet's disease. In fact, the treatments were well tolerated, no sign of scarring or hyper/hypopigmentation was reported and we obtained a significant improvement of the lesions in terms of color and size of them.
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Affiliation(s)
- Paolo Fioramonti
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome Sapienza , Policlinico Umberto I, Rome , Italy
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Gaffo AL. Thrombosis in vasculitis. Best Pract Res Clin Rheumatol 2013; 27:57-67. [PMID: 23507057 DOI: 10.1016/j.berh.2012.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 12/28/2012] [Accepted: 12/30/2012] [Indexed: 12/12/2022]
Abstract
Thrombo-embolic disease is an increasingly recognised complication of several vasculitides. A common observation is that thrombo-embolic complications coincide with periods of increased vasculitis disease activity, but the mechanism through which this happens is still unknown. Thrombo-embolic disease has been recognised for decades as a significant contributor to the morbidity and mortality of Behçet's disease, and the role of anticoagulation in its management is being minimised in favour of immunosuppression, although evidence from randomised controlled trials is lacking. Ancillary data from a randomised clinical trial and retrospective observational studies have confirmed an association between venous thrombo-embolic disease and vasculitides associated with anti-neutrophil cytoplasmic antibodies (ANCAs). An increased cardiovascular risk is now also recognised for vasculitides associated with ANCAs. Thrombosis plays a prominent role in the pathogenesis of thromboangiitis obliterans (Buerger's disease). The association of thrombosis with other vasculitides such as giant-cell arteritis and levamisole-induced vasculopathy is under investigation.
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Affiliation(s)
- Angelo L Gaffo
- Rheumatology Section, Veterans Affairs Medical Center, Birmingham, AL, USA.
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Major vascular involvement in Behçet's disease: a retrospective study of 796 patients. Clin Rheumatol 2013; 32:845-52. [PMID: 23443336 DOI: 10.1007/s10067-013-2205-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/09/2013] [Accepted: 01/26/2013] [Indexed: 12/12/2022]
Abstract
Behçet's disease (BD) is a multi-systemic inflammatory disorder which can affect all types and sizes of blood vessels. This study aims to evaluate the prevalence and characteristics of vascular involvement in BD. Among 796 patients diagnosed with BD, 102 patients (81 male, 21 female) with vascular involvement were included, whose detailed clinical characteristics were recorded. The diagnosis of vascular lesions was made on clinical signs, by Doppler ultrasonography, and/or angiography using computed tomographic or magnetic resonance techniques. Vascular involvement occurred in 12.8 % of BD patients. Male to female ratio was 3.86:1. Mean age at onset of vascular involvement was 29.5 ± 11.3 years. Vascular lesion was the initial sign of BD in 28 patients, accounting for 27.5 %. Of 102 BD patients with vascular involvement, 72 had venous lesions (70.6 %) and 56 had arterial lesions (54.9 %), among which 26 (25.5 %) patients had both venous and arterial involvements. Female BD patients were more often involved with arterial lesions, whereas male BD patients developed venous lesions more often than females, P = 0.000. The most common type of vascular involvement was deep venous thrombosis in lower extremities (n = 49), other affected venous sites including inferior vena cava, superior vena cava, and cerebral venous. The prominent type of arterial lesions was dilatation (n = 25, including 24 cases of aneurysms); other types included eight cases of occlusion and 23 cases of stenosis. The main locations of arterial lesions were the aorta (n = 19), lower extremity arteries (n = 15), pulmonary arteries (n = 13), coronary arteries (n = 5), and subclavian arteries (n = 5). Compared with those without vascular lesions, ocular involvement, genital ulcers, and arthritis were significantly less frequent among patients with vasculo-BD (23.5 vs 35.2 %, P = 0.024; 54.9 vs 76.5 %, P = 0.000; 19.6 vs 30.5 %, P = 0.026), whereas a higher frequency of cardiac involvement was found in vasculo-BD patients (20.6 vs 3.6 %, P = 0.000). Vascular involvement is a complication in BD patients. This study illustrated that venous lesions are more frequently involved than arterial lesions. Vascular lesions correlated with a high frequency of cardiac involvement and a low incidence of ocular lesions, genital ulcers, and arthritis.
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Venous thromboembolic disease in systemic autoimmune diseases: An association to keep in mind. Autoimmun Rev 2012; 12:289-94. [DOI: 10.1016/j.autrev.2012.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/01/2012] [Indexed: 11/18/2022]
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Malik AA, Halabi AM, Jamil G, Qureshi A. Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging. BMJ Case Rep 2012; 2012:bcr-2012-007148. [PMID: 23045452 DOI: 10.1136/bcr-2012-007148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A young Jordanian man was hospitalised with fever of 2 months duration. Preadmission diagnostic assessment including CT thorax and abdomen were inconclusive. Right-sided pleuritic chest pain was present on admission. Pulmonary embolism was suspected on a ventilation/perfusion lung scan. Lower-extremity deep venous thrombosis was, however, absent. Echocardiogram to exclude a cardiac source of pulmonary embolism showed a right ventricle mass which was also present on retrospective review of prehospitalisation CT thorax. Tissue characterisation of this mass on cardiac MRI was not helpful. Empiric anticoagulation was started without reduction in size at 3 weeks. Due to ongoing diagnostic uncertainty, surgical resection was performed. Histopathology confirmed this mass to be a thrombus. With unabated fever, right ventricular thrombosis with pulmonary embolism and cutaneous and scrotal ulceration which evolved later in the hospital course, a diagnosis of Bechet's syndrome was considered and subsequently confirmed. Response to immunosuppressive therapy was prompt.
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Affiliation(s)
- Azhar Ali Malik
- Department of Internal Medicine, Tawam Hospital, Alian, AbuDhabi, UAE.
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Owlia MB, Mehrpoor G. Behcet's Disease: New Concepts in Cardiovascular Involvements and Future Direction for Treatment. ISRN PHARMACOLOGY 2012; 2012:760484. [PMID: 22530146 PMCID: PMC3317002 DOI: 10.5402/2012/760484] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/15/2011] [Indexed: 01/02/2023]
Abstract
Behcet's disease (BD) is the only systemic vasculitis involving both arteries and vein in any sizes. It frequently encounters in rheumatology clinics. It has some major morbidities and even fatal outcomes in some cases. The aim of this paper is to analyze the main concepts on pathophysiology and treatment options in BD, focusing on cardiovascular aspects, thrombosis, and potential future treatment.
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Affiliation(s)
- M. B. Owlia
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - G. Mehrpoor
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Dagan E, Baruch Y, Fiorilli M, Rozenbaum M, Rosner I, Gershoni-Baruch R. Vascular Behcet and Mutations in Thrombogenic Genes: Methylene Tetrahydrofolate Reductase, Factor V, and Prothrombin. Genet Test Mol Biomarkers 2012; 16:30-5. [DOI: 10.1089/gtmb.2011.0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Efrat Dagan
- Department of Nursing, University of Haifa, Haifa, Israel
- Institute of Human Genetics, RAMBAM Health Care Campus, Haifa, Israel
| | - Yoav Baruch
- Department of Clinical Medicine, University of “La Sapienza,” Rome, Italy
| | - Massimo Fiorilli
- Department of Clinical Medicine, University of “La Sapienza,” Rome, Italy
| | - Michael Rozenbaum
- Department of Rheumatology, Bnei-Zion Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Department of Rheumatology, Bnei-Zion Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Ruth Gershoni-Baruch
- Institute of Human Genetics, RAMBAM Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
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34
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Ibrahim SE, Elshishtawy HF, HelmySamy A, Galal ZA. Role of vascular endothelial growth factor and monocyte chemoattractant protein-1 in Behçet's disease. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60202-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schreiber BE, Noor N, Juli CF, Haskard DO. Resolution of Behçet's Syndrome Associated Pulmonary Arterial Aneurysms with Infliximab. Semin Arthritis Rheum 2011; 41:482-7. [DOI: 10.1016/j.semarthrit.2011.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/27/2022]
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DAVATCHI F, SHAHRAM F, CHAMS-DAVATCHI C, SADEGHI ABDOLLAHI B, SHAMS H, NADJI A, FAEZI T, AKHLAGHI M, GHODSI Z, LARIMI R, ASHOFTEH F. Behcet’s disease: is there a gender influence on clinical manifestations? Int J Rheum Dis 2011; 15:306-14. [DOI: 10.1111/j.1756-185x.2011.01696.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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37
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Macey M, Hagi-Pavli E, Stewart J, Wallace GR, Stanford M, Shirlaw P, Fortune F. Age, gender and disease-related platelet and neutrophil activation ex vivo in whole blood samples from patients with Behçet's disease. Rheumatology (Oxford) 2011; 50:1849-59. [PMID: 21719422 DOI: 10.1093/rheumatology/ker177] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Behçet's disease (BD) is more severe among young males and disease severity decreases with age. Therefore, the effect of disease activity, gender and age on platelet and neutrophil activation in whole blood taken from patients with BD was investigated. METHODS Using an anti-coagulant Tripotassium ethylenediaminetetra acetic acid (K3EDTA) plus citrate-theophylline-adenosine-dipyridamole (CTAD) (K3EDTA/CTAD) that preserves the degree of platelet activation that exists in vivo, we assessed neutrophil and platelet activation, microparticles, and monocyte and neutrophil-platelet aggregate formation in 43 BD patients using flow cytometry. This is the first description of platelet activation and microparticles in BD patients using this methodology. RESULTS Inactive [2.78 (0.56)%, P = 0.0009; 3.11 (0.78)%, P < 0.0001] and active [2.28 (0.84)%, P < 0.0001; 3.071 (0.67)%, P = 0.0031] BD patients had significantly higher percentages of CD62P-expressing platelets and CD62P+ platelet microparticles as compared with healthy controls (HCs) [0.84 (0.1)% and 1.23 (0.14)%], respectively. The percentages of CD62P+ platelets and CD62P+ platelet microparticles in female and male BD patients were also significantly higher than those expressed by female and male HCs. The percentages of CD62P+ microparticles were significantly increased in the 20-30-(P = 0.0301) and 31-50-(P < 0.0162) year age ranges, but not in the >50-year age group of BD patients. CONCLUSION BD is a rare, chronic multi-systemic vasculitis and interaction of activated platelets with leucocytes has been linked to pathological disorders associated with vascular inflammation. Importantly, this study demonstrates that platelet microparticle activation is increased in BD. Also, this is the first report in which changes in platelet activation in BD are concordant with the observations that BD disease activity diminishes with age.
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Affiliation(s)
- Marion Macey
- Department of Haematology, The Royal London Hospital,Whitechapel, UK
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38
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Kotsis T, Moulakakis KG, Mylonas S, Andrikopoulos V. Vascular manifestations of Behcet's disease: report of a case and review of the literature. Phlebology 2011; 26:249-53. [PMID: 21478143 DOI: 10.1258/phleb.2010.010024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adamantiades-Behçet's disease (ABD) is a relapsing vasculitis of unknown aetiology and variable clinical manifestations. The syndrome can be presented in a myriad of ways and can involve nearly every organ. Although vascular involvement is not included among the ABD diagnostic criteria, it is a unique clinical manifestation in adults with a potentially devastating outcome. We report an ABD case, presenting with a thrombotic occlusion of the inferior vena cava. The authors review the recent literature, emphasizing the spectrum of vascular manifestations accompanying Behçet's disease.
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Affiliation(s)
- T Kotsis
- Department of Vascular Surgery, 'Red Cross' General Hospital, Andrea Papandreou 132 Street, Glyfada, Athens 16561, Greece
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39
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Davatchi F, Shahram F, Shams H, Nadji A, Chams-Davatchi C, Akhlaghi M, Faezi ST, Ashofteh F, Sadeghi-Abdollahi B. Gender influence on ocular manifestations and their outcome in Behcet’s Disease. A long-term follow-up of up to 20 years. Clin Rheumatol 2010; 30:541-7. [DOI: 10.1007/s10067-010-1574-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/01/2010] [Accepted: 09/07/2010] [Indexed: 01/23/2023]
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40
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Donmez A, Aksu K, Aydın H, Keser G, Cagirgan S, Doganavsargil E, Tombuloglu M. The plasma levels of activated thrombin activatable fibrinolysis inhibitor and thrombomodulin in Behçet Disease and their association with thrombosis. Thromb Res 2010; 126:207-10. [DOI: 10.1016/j.thromres.2010.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/16/2010] [Accepted: 05/16/2010] [Indexed: 10/19/2022]
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41
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A severe renal bleeding as a complication of coumarin therapy in Behçet's disease. Blood Coagul Fibrinolysis 2010; 21:487-90. [DOI: 10.1097/mbc.0b013e328338cded] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Alkaabi JK, Pathare A. Pattern and outcome of vascular involvement of Omani patients with Behcet’s disease. Rheumatol Int 2010; 31:731-5. [DOI: 10.1007/s00296-010-1363-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 01/16/2010] [Indexed: 11/24/2022]
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Acikgoz N, Karincaoglu Y, Ermis N, Yagmur J, Atas H, Kurtoglu E, Cansel M, Barutcu I, Pekdemir H, Özdemir R. Increased Mean Platelet Volume in Behçet's Disease with Thrombotic Tendency. TOHOKU J EXP MED 2010; 221:119-23. [DOI: 10.1620/tjem.221.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nusret Acikgoz
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Necip Ermis
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Jülide Yagmur
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Halil Atas
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Mehmet Cansel
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Hasan Pekdemir
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Ramazan Özdemir
- Inonu University Faculty of Medicine, Department of Cardiology
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Abstract
PURPOSE OF REVIEW To give an overview of recent clinical findings of thromboembolic disease in vasculitis and provide insight into possible explanations of the association between thrombosis and inflammation. RECENT FINDINGS A high incidence of venous thrombotic events has recently been described in four distinct cohorts of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), especially during periods of active disease. No factors other than the vasculitis itself have been identified that explain this high occurrence of thrombosis. Several studies have shown an increased rate of thrombosis in Behçet's disease, with a different clinical presentation from that observed in AAV. Recent laboratory findings provide exciting insights into a bidirectional feedback loop between coagulation and inflammation that may be applicable to vasculitis. SUMMARY Thrombosis is an important clinical manifestation of some types of vasculitis. Better understanding of the association of thrombosis with inflammation in vasculitis might lead to development of clinically useful biomarkers and new approaches to therapy. Additionally, study of the specific factors involved in thrombosis in systemic vasculitis could help explain the role of inflammation in more common settings of venous thrombotic events.
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Affiliation(s)
- Gunnar Tomasson
- The Vasculitis Center, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118, USA
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45
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Martínez M, Ricart J, Ruiz-Aja S, Rus A, Todolí J, Calvo J, Vayá A. Platelet Activation and Red Blood Cell Phosphatidylserine Exposure Evaluated by Flow Cytometry in Patients with Behçet’s Disease: Are They Related to Thrombotic Events? PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2008; 36:18-22. [DOI: 10.1159/000112635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 07/26/2007] [Indexed: 12/21/2022]
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48
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Kandolf-Sekulovic L, Pavlovic MD, Glisic B, Petronijevic M, Ristic G, Mijuskovic Z, Zecevic RD, Stefanovic D. Adamantiades-Behçet's disease, deep venous thrombosis and anticardiolipin antibodies: report of two cases. J Eur Acad Dermatol Venereol 2005; 19:484-6. [PMID: 15987300 DOI: 10.1111/j.1468-3083.2005.01193.x] [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: 11/26/2022]
Abstract
Vascular thrombosis was found in different proportions of patients with Adamantiades-Behçet's disease (ABD), depending on the ethnicity of the population under study. Various thrombophilic factors, including the levels of anticardiolipin antibodies (ACA), were investigated for their role in the thrombotic process with conflicting results. The prevalence of ACA varies considerably in different studies, but their presence has not been associated with increased risk for vascular thrombosis. We present two cases with ABD, deep venous thrombosis (DVT) and elevated levels of ACA that fulfil the criteria for both ABD and antiphospholipid syndrome (APS).
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Affiliation(s)
- L Kandolf-Sekulovic
- Department of Dermatology, Military Medical Academy, 17 Crnotravska, 11002 Belgrade, Serbia and Montenegro.
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49
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Hamdan A, Mansour W, Uthman I, Masri AF, Nasr F, Arayssi T. Behçet's disease in Lebanon: clinical profile, severity and two-decade comparison. Clin Rheumatol 2005; 25:364-7. [PMID: 16292470 DOI: 10.1007/s10067-005-0058-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 06/14/2005] [Accepted: 06/16/2005] [Indexed: 12/27/2022]
Abstract
The aim of this study is to describe the clinical features of Lebanese patients with Behçet's disease (BD) followed up at a tertiary care center in Lebanon. A retrospective review of medical records of 90 patients who fulfilled the International Study Group (ISG) criteria for diagnosis was performed. The clinical characteristics and severity score were compared with those reported from other populations of Arab and of Turkish origin using the same diagnostic criteria, and a comparison over two decades for the Lebanese population was made. The male-to-female ratio was 2.9:1, the mean age at onset, 25.4 years, and mean age at diagnosis, 29.2 years. One hundred percent of the patients had mouth ulceration; 72.2%, genital ulceration; 59.1%, arthritis; 55.7%, papulopustular skin lesion; 53.9%, ocular disease; 36.8%, vascular disease; 29.5%, erythema nodosum; and 23.0%, neurologic disease. The characteristics of our patient population are similar to that reported from other countries in the region. However, we found a higher prevalence of vascular and neurologic disease.
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Affiliation(s)
- Ayad Hamdan
- Division of Rheumatology, Internal Medicine Department, American University of Beirut-Medical Center, Box 11-0236, Bliss Street, Beirut, Lebanon.
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50
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Köksal AS, Ertugrul I, Dişibeyaz S, Tola M, Kacar S, Arhan M, Aydin F, Ulker A. Crohn's and Behçet's disease association presenting with superior vena cava thrombosis. Dig Dis Sci 2005; 50:1698-701. [PMID: 16133972 DOI: 10.1007/s10620-005-2918-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Accepted: 11/09/2004] [Indexed: 01/20/2023]
Abstract
A 21-year-old male patient with a 6-year history of Crohn's disease presented with shoulder pain and edema in the neck and bilateral supraclavicular fossa. Color Doppler ultrasonography and computed tomography scan revealed bilateral thrombosis of the external jugular veins, brachiocephalic veins, and superior vena cava. Other etiologies were appropriately ruled out and the thrombosis was initially attributed to Crohn's disease. In the follow-up, the patient developed recurrent, painful orogenital ulcers and acne vulgaris-like skin eruptions. HLA tissue typing was HLA B-51. The diagnosis of Crohn's disease associated with Behçet's disease was made. Although there are several case reports describing such an association, a Medline research revealed that this was the first presentation of such an association with thrombosis. Thrombosis in unusual sites may reflect the uncommon association of Crohn's disease with hypercoagulable conditions such as Behçet's disease.
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Affiliation(s)
- Aydin Seref Köksal
- Departments of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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