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Ghembaza A, Boussouar S, Saadoun D. [Thoracic manifestations of Behcet's disease]. Rev Mal Respir 2022; 39:523-533. [PMID: 35659162 DOI: 10.1016/j.rmr.2022.04.010] [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: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).
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Affiliation(s)
- A Ghembaza
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France
| | - S Boussouar
- Cardiovascular and Thoracic Imaging Unit, hôpital Pitié Salpêtrière, AP-HP, Paris, France; Inserm, laboratoire d'imagerie biomédicale, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - D Saadoun
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France.
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Kakiuchi M, Ohashi Y, Tsuji M, Fujii T. Aortic regurgitation due to aortic valve perforation and aortitis in Behçet’s disease. Eur Heart J Case Rep 2021; 5:ytab227. [PMID: 34263125 PMCID: PMC8274653 DOI: 10.1093/ehjcr/ytab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Minami Kakiuchi
- Department of cardiology, Ako City Hospital, 1090 Nakahiro, Ako, Hyogo 678-0232, Japan
| | - Yoshitaka Ohashi
- Department of cardiology, Ako City Hospital, 1090 Nakahiro, Ako, Hyogo 678-0232, Japan
| | - Maako Tsuji
- Department of cardiology, Ako City Hospital, 1090 Nakahiro, Ako, Hyogo 678-0232, Japan
| | - Takashi Fujii
- Department of cardiology, Ako City Hospital, 1090 Nakahiro, Ako, Hyogo 678-0232, Japan
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Fisher CA, Bernard C. A Systematic Review of Neurocognitive Functioning in Behçet's Disease. Neuropsychol Rev 2019; 29:498-521. [PMID: 31494834 DOI: 10.1007/s11065-019-09416-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
Behçet's disease (BD) is a vascular, inflammatory multisystem disorder with neuro-Behçet's (NBD) diagnosed in a subset of patients with neurological manifestations. The objective of this review was to determine whether neurocognitive dysfunction is observed in BD, in which neurocognitive domains, and whether there are differences in rates of dysfunction observed between BD and NBD groups. Studies of any methodology were included that reported results from standardized neurocognitive assessment measures in participants with BD or NBD. Twelve group comparison studies met the criteria for inclusion in the review (totalling 284 BD and 157 NBD participants), as well as 17 case study/series papers (11 BD, 35 NBD). Issues with blinding, incomplete data reporting and selective reporting bias were found across the group and case study/series papers, as well as inadequate statistical adjustment for multiple comparisons in the group studies, and the lack of the use of appropriate norms or adjustment for premorbid ability in the case series/studies papers. These quality issues impacted on the conclusions that could be drawn from the current literature. Neurocognitive dysfunction was found in NBD compared to health controls (HC) in a higher proportion of results across studies, than in comparisons between BD and HC groups. The domains in which neurocognitive attenuation was most often reported were visual spatial ability, working memory and acquired knowledge, with more than 25% of these results showing significantly lower functioning in both the BD and NBD groups compared to HC. More than 25% of the processing speed and long-term memory encoding and retrieval results were also lower for the NBD group, compared to HC. Group comparisons between NBD and multiple sclerosis participants indicated few significant differences in neurocognitive test results. The majority of case study/series participants were found to have some degree of attenuated neurocognitive functioning, as defined by case study/series authors.
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Affiliation(s)
- Caroline A Fisher
- Allied Health - Psychology, Melbourne Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Victoria, 3052, Australia.
- Neuropsychology Service, The Melbourne Clinic, Healthscope, Richmond, Melbourne, Australia.
| | - Coco Bernard
- Allied Health - Psychology, Melbourne Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Victoria, 3052, Australia
- Adult Neuropsychology Service, Rehabilitation and Aged Care Services, Monash Health, Kingston Centre, Cheltenham, Australia
- Adult Neuropsychology Service, Rehabilitation and Aged Care, Monash Health, Caulfield Hospital, Caulfield, Australia
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Nanthapisal S, Klein NJ, Ambrose N, Eleftheriou D, Brogan PA. Paediatric Behçet's disease: a UK tertiary centre experience. Clin Rheumatol 2016; 35:2509-16. [PMID: 26833394 PMCID: PMC5031738 DOI: 10.1007/s10067-016-3187-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/01/2015] [Accepted: 01/14/2016] [Indexed: 01/15/2023]
Abstract
There are currently limited data regarding paediatric Behçet's disease (BD), particularly in the UK. We describe the clinical spectrum, treatment and outcome of BD, and explore the relative sensitivities of the criteria for the diagnosis of BD in a UK paediatric cohort. Single retrospective case note review of children with a clinical diagnosis of BD presenting between 1987 and 2012. Demographics, clinical features, treatment and outcomes were recorded. The sensitivities of the International Study Group (ISG) and International Criteria for BD (ICBD) criteria were explored. BD disease activity was calculated using the Behçet's Disease Activity Index (BDAI). Forty-six patients (22 male) were identified. Median age of onset was 4.87 (0.04-15.71) years; median time to diagnosis was 3.74 (0.25-13.48) years. Clinical features were recurrent oral ulceration (97.8 %), recurrent genital ulceration (73.9 %), gastrointestinal (58.7 %), musculoskeletal (47.83 %), cutaneous (23.9 %) involvement and uveitis (2 %). Recurrent genital ulceration was more common in female patients (P = 0.044). Thirty-seven patients (80.4 %) fulfilled the ICBD criteria; only 12 patients (26.1 %) fulfilled the ISG criteria. BDAI score at diagnosis was 7/20 (0-10/20) and significantly decreased to 5/20 (0-9/20) (P < 0.0001) at latest follow-up. The commonest systemic treatment was colchicine (76.1 %); anti-TNFα treatment was reserved for severe cases (15.5 %). Paediatric BD in the UK may present very early in life, sometimes with a family history, and with a low incidence of ocular involvement. Diagnostic delay is common. The majority of our patients required systemic therapy; anti-TNFα was reserved for severe cases and has largely superseded the use of thalidomide.
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Affiliation(s)
- Sira Nanthapisal
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Nigel J Klein
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Nicola Ambrose
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paul A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
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Fisher CA, Sewell K, Baker A. Chronic behavior disturbance and neurocognitive deficits in neuro-Behcet's disease: a case study. Neurocase 2016; 22:332-8. [PMID: 27223331 DOI: 10.1080/13554794.2016.1186701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Behcet's disease is a vasculitis and multisystem inflammatory syndrome. Neurological abnormalities occur in a subset of patients. This report presents a case of neuro-Behcet's disease characterized by an initial onset of behavior changes prior to diagnosis, which evolved into a chronic behavioral syndrome. Neuroimaging investigations revealed progressive periventricular white matter and brainstem atrophy and lesions in the basal ganglia and deep white matter tracts, while neuropsychological investigations revealed reductions in information processing, executive functioning, and memory. The case indicates that behavior changes may be the first symptoms to emerge in Behcet's, before other defining features of the disease.
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Affiliation(s)
- Caroline A Fisher
- a Brain Disorders Program , Austin Health , Melbourne , Australia.,b The Melbourne Clinic , Melbourne , Australia.,c Psychology Department , Royal Melbourne Hospital , Melbourne , Australia
| | - Katherine Sewell
- a Brain Disorders Program , Austin Health , Melbourne , Australia
| | - Amy Baker
- d Department of Radiology , Austin Health , Melbourne , Australia
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Elsharawy MA, Elsaid A, Al-Dhafery B, Alghnimi I, Almabyouq F. Durability of aneurysm treatments in patients with active Behcet's disease. Vascular 2015; 24:454-60. [PMID: 26519256 DOI: 10.1177/1708538115611069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aneurysms in Behcet's disease are rare, serious, and recurrent. To achieve durable treatment, patients should receive immunosuppressive therapy before intervention to induce remission. We present early and long-term results of emergency cases of active Behcet's disease, which did not permit waiting for suppressive treatment. PATIENTS AND METHODS The study was undertaken on all cases admitted to the vascular unit, King Fahd Hospital of University for aneurysm treatment in patients with active Behcet's disease over about 10 years. All patients had exclusion of the aneurysm either by open surgery or endovascular intervention. Morbidities and mortality were recorded within the hospital admission and on the follow-up. RESULTS During the study period, three cases were included. All interventions were successful and lifesaving. However, two cases, treated with surgical interposition grafts, were blocked in the intermediate term follow-up (2-12 months) and one case, treated with endovascular treatment, complicated with pseudoaneurysm at femoral puncture site after six months. CONCLUSION Although early results were good, intermediate ones were not satisfactory because of progressive graft thrombosis and formation of new aneurysms. Awareness of these rare cases help for early identification and proper immunosuppressive before emergency vascular intervention is warranted.
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Affiliation(s)
- Mohamed A Elsharawy
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
| | - Aymen Elsaid
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
| | - Bander Al-Dhafery
- Department of Radiology, University of Dammam, Al-Khobar, Saudi Arabia
| | - Ibrahim Alghnimi
- Department of Radiology, University of Dammam, Al-Khobar, Saudi Arabia
| | - Fatimah Almabyouq
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
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