1
|
Karatemiz G, Esatoglu SN, Gurcan M, Ozguler Y, Yurdakul S, Hamuryudan V, Fresko I, Melikoglu M, Seyahi E, Ugurlu S, Ozdogan H, Yazici H, Hatemi G. Frequency of AA amyloidosis has decreased in Behçet's syndrome: a retrospective study with long-term follow-up and a systematic review. Rheumatology (Oxford) 2022; 62:9-18. [PMID: 35657376 DOI: 10.1093/rheumatology/keac223] [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: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE A decline in the frequency of AA amyloidosis secondary to RA and infectious diseases has been reported. We aimed to determine the change in the frequency of AA amyloidosis in our Behçet's syndrome (BS) patients and to summarize the clinical characteristics of and outcomes for our patients, and also those identified by a systematic review. METHODS We identified patients with amyloidosis in our BS cohort (as well as their clinical and laboratory features, treatment, and outcome) through a chart review. The primary end points were end-stage renal disease and death. The prevalence of AA amyloidosis was estimated separately for patients registered during 1976-2000 and those registered during 2001-2017, in order to determine whether there was any change in the frequency. We searched PubMed and EMBASE for reports on BS patients with AA amyloidosis. Risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. RESULTS The prevalence of AA amyloidosis was 0.62% (24/3820) in the earlier cohort and declined to 0.054% (3/5590) in the recent cohort. The systematic review revealed 82 cases in 42 publications. The main features of patients were male predominance and a high frequency of vascular involvement. One-third of patients died within 6 months after diagnosis of amyloidosis. CONCLUSION The frequency of AA amyloidosis has decreased in patients with BS, which is similar to the decrease observed for AA amyloidosis due to other inflammatory and infectious causes. However, AA amyloidosis is a rare, but potentially fatal complication of BS.
Collapse
Affiliation(s)
- Guzin Karatemiz
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Gurcan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebahattin Yurdakul
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hasan Yazici
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
2
|
Mora P, Menozzi C, Orsoni JG, Rubino P, Ruffini L, Carta A. Neuro-Behçet's disease in childhood: a focus on the neuro-ophthalmological features. Orphanet J Rare Dis 2013; 8:18. [PMID: 23360593 PMCID: PMC3567996 DOI: 10.1186/1750-1172-8-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/23/2013] [Indexed: 02/01/2023] Open
Abstract
Neuro-Behçet's disease (NBD) involves the central nervous system; peripheral nervous system involvement is not often reported. NBD is quite common in adult patients and occurs rarely during childhood and adolescence. Young patients may share symptoms and signs of NBD with other neuro-ophthalmological disorders (e.g. idiopathic intracranial hypertension); thus, making the differential diagnosis difficult. Neuroimaging is mandatory and necessary for a correct NBD diagnosis but in children radiological examinations are often difficult to perform without sedation. From 1971 to 2011, 130 patients aged ≤16 years have been reported with NBD, according to retrospective surveys, case series, and case reports. The origin of the reported cases met the well-known geographical distribution of Behçet's disease (BD); the mean age at presentation of neurological findings was 11.8 years, with male gender prevalence (ratio, 2.9:1). We considered in detail the neuro-ophthalmological features of the 53 cases whose neuroimaging alterations were described with an assigned radiological pattern of the disease (parenchymal: 14 cases, non-parechymal: 35 cases, and mixed: 4 cases). In 19/53 patients (36%), neuro-ophthalmological symptoms anticipated any pathognomonic sign for a BD diagnosis, or only occasional aphtae were recalled by the patients. Family history was positive in 17% of subjects. Headache was reported in 75% of the patients; in those presenting with cerebral vascular involvement, headache was combined to other symptoms of intracranial hypertension. Papilledema was the most frequently reported ophthalmological finding, followed by posterior uveitis. Treatment consisted of systemic steroids in 93% of patients, often combined with other immunosuppressive drugs (especially colchicine and azathioprine). Clinical recovery or improvement was documented in the large majority of patients. Nine subjects had definitive alterations, and one died. Based on our review and personal experience, a delayed diagnosis, and the consequently delayed immunosuppressive treatment, may favour permanent sequelae, in particular, optic atrophy.
Collapse
Affiliation(s)
- Paolo Mora
- Institute of Ophthalmology - Department of Biological, Biotechnological, and Translational Sciences, University of Parma, via Gramsci 14, 43126, Parma, Italy.
| | | | | | | | | | | |
Collapse
|
3
|
Iwadate H, Ohira H, Saito H, Takahashi A, Rai T, Takiguchi J, Sasajima T, Kobayashi H, Watanabe H, Sato Y. A case of primary biliary cirrhosis complicated by Behçet’s disease and palmoplantar pustulosis. World J Gastroenterol 2006; 12:2136-8. [PMID: 16610072 PMCID: PMC4087700 DOI: 10.3748/wjg.v12.i13.2136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 46-year-old woman was diagnosed with palmoplantar pustulosis (PPP) at the Department of Dermatology, Fukushima Medical University Hospital in 2000, and was treated with ointment. However, because liver dysfunction developed in 2003, she was referred to our department, where primary biliary cirrhosis (PBC) was also diagnosed on the basis of clinical findings. One year later, at the age of 49, she developed manifestations of Behçet’s disease (BD), including erythema nodosum in the lower extremities. Because she had a history of uveitis, recurrent oral ulceration was present, and the HLA typing was positive for B51, BD was additionally diagnosed. Liver function normalized within three months of the start of treatment with ursodesoxycholic acid (UDCA). This is the first case of PBC associated with BD and PPP.
Collapse
Affiliation(s)
- Haruyo Iwadate
- Department of Internal Medicine II, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Akpolat T, Akkoyunlu M, Akpolat I, Dilek M, Odabas AR, Ozen S. Renal Behçet's disease: a cumulative analysis. Semin Arthritis Rheum 2002; 31:317-37. [PMID: 11965596 DOI: 10.1053/sarh.2002.31721] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyze cumulated data about renal involvement in Behçet's disease (BD) and to report on 6 patients with BD and renal problems. METHODS We found reports of 159 patients (including our patients) with BD and specific renal disease (amyloidosis 69, glomerulonephritis [GN] 51, renal vascular disease 35, and interstitial nephritis 4) in our survey. RESULTS The frequency of renal problems among BD patients has been reported to vary between 0% to 55%. Male gender is a risk factor for all types of renal BD. Nephrotic syndrome was present in 83% of patients with amyloidosis, and renal failure was common at the time of diagnosis. The mean interval between the initial manifestation of BD and diagnosis of amyloidosis was shorter in men than in women (P =.02). AA-type amyloid fibrils were shown in all cases studied. Vascular involvement was common in the patients with amyloidosis (60%). The renal findings in GN show a wide spectrum, from asymptomatic hematuria and/or proteinuria to rapidly progressive GN. Several types of glomerular lesions ranging from minor glomerular changes to crescentic glomerulonephritis are observed in BD. The common types of glomerular lesions among the reported cases are crescentic GN, proliferative GN, and immunoglobulin A (IgA) nephritis. Aneurysms may be located throughout the renal artery, from the orifice of the main artery to intrarenal microaneurysms. Another type of renal disease (amyloidosis or GN) and other major vascular involvement were present in all cases with renal vein thrombosis. Hypertension is common among patients with renal artery aneurysm or stenosis. Microscopic vascular disease was described in 4 patients. CONCLUSIONS Based on data in the literature, we suggest that renal involvement in BD is more frequent than has been recognized, although it is most often mild in nature. Amyloidosis is one of the prognostic factors affecting survival. Patients with vascular involvement carry high risk for amyloidosis, and administration of colchicine to these patients may be beneficial. More evidence is needed to accept interstitial nephritis as a manifestation of BD. In spite of some difficulties, hemodialysis and renal transplantation are safe treatment options in BD-related uremia.
Collapse
Affiliation(s)
- Tekin Akpolat
- Ondokuz Mayis University School of Medicine, Samsun-Turkey.
| | | | | | | | | | | |
Collapse
|
5
|
Abstract
Behçet's disease is a complex multisystem disease diagnosed by means of clinical criteria. Clinical features include oral and genital aphthae, pustular vasculitic cutaneous lesions, and ocular, gastrointestinal, and vascular manifestations. We believe that complex aphthosis, characterized by oral or oral and genital ulcers, may be a forme fruste of Behçet's disease. Although the pathogenesis of both Behçet's disease and complex aphthosis remain unknown, immune factors, infectious agents, and effector mechanisms are implicated. Treatment is based on the severity of systemic involvement and includes topical therapies as well as colchicine, dapsone, thalidomide, and immunosuppressive agents.
Collapse
Affiliation(s)
- J V Ghate
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | |
Collapse
|
6
|
Abstract
OBJECTIVE The aim of this study is to determine the clinical features and outcome of Behçet's disease in the pediatric age group. METHOD Twenty cases within a pediatric age group whose ages differ from 5 to 15 years were studied retrospectively to determine the age of onset, the initial signs, and the progress of the disease. RESULTS In 18 of the patients whose average age were 13.3 years (5 to 18 years), the initial symptoms associated with Behçet's disease were oral aphtous lesions or genital ulcers. Among them, 16 developed ocular symptoms in a later stage, at an average of 15.5 years of age (11 to 18 years). Posterior uveitis was the most common manifestation, detected in 75% of the cases. Three patients had neurobehçet's disease, and the neurologic manifestations were dural thrombosis, pseudotumor cerebri, and quadriparesis. CONCLUSIONS In this study, after an average 4 years' follow up (6 months to 13 years) the clinical progress of Behçet's disease in the pediatric age group was similar to that found in adult disease. Both the ocular signs (i.e., cataracts and glaucoma) and the systemic features (i.e., aphtous stomatitis, genital ulcers, erythema nodosum, arthritis, and neurologic signs) were manifested at the onset or during the progress of the disease.
Collapse
Affiliation(s)
- B Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | | | | |
Collapse
|
7
|
Akpolat I, Akpolat T, Danaci M, Bariş YS, Kaya N, Kandemir B. Behçet's disease and amyloidosis. Review of the literature. Scand J Rheumatol 1998; 26:477-9. [PMID: 9433411 DOI: 10.3109/03009749709065723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this report, we present a patient with BD, amyloidosis and end-stage-renal-disease and discuss the literature on BD and amyloidosis. Forty-four patients with BD and amyloidosis are described in the literature. The type of amyloid fibrils were studied in 27 of this 44 patients and all were AA. The interval between the onset of first symptom of BD and the diagnosis of amyloidosis ranged from one to 27 years. This clinical observation and AA type amyloid fibrils in BD suggest that amyloidosis is secondary to inflammation. Behçet's disease should be considered in the differential diagnosis of AA amyloidosis.
Collapse
Affiliation(s)
- I Akpolat
- Department of Pathology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | | | | | | | | | | |
Collapse
|
8
|
Livneh A, Zemer D, Langevitz P, Shemer J, Sohar E, Pras M. Colchicine in the treatment of AA and AL amyloidosis. Semin Arthritis Rheum 1993; 23:206-14. [PMID: 8122124 DOI: 10.1016/s0049-0172(05)80042-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Colchicine is an effective medication in the prevention and treatment of amyloidosis of familial Mediterranean fever. Its therapeutic effect depends on the stage of renal disease and the drug dose. To evaluate colchicine effect in AA amyloidosis of other diseases and in primary AL amyloidosis, the literature was reviewed. Findings were that (1) the effect of colchicine in reactive amyloidosis has not been methodically studied, but anecdotal reports suggest it may be beneficial; and (2) the results of studies and case reports on the effect of colchicine in primary amyloidosis are conflicting. Because a therapeutic effect of colchicine in primary and reactive amyloidosis has been shown in sporadic cases, a prospective, controlled, multicenter study assessing the effect of colchicine in all types of amyloidosis appears to be justified. Until such a study is available, the addition of colchicine in an appropriate dose to any therapeutic regimen of patients with AA or AL amyloidosis should be considered.
Collapse
Affiliation(s)
- A Livneh
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
9
|
Erkan F, Cavdar T. Pulmonary vasculitis in Behçet's disease. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1992; 146:232-9. [PMID: 1626807 DOI: 10.1164/ajrccm/146.1.232] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Clinical findings of 12 patients with Behçet's disease and lung involvement are presented. Male to female ratio was 11/1, mean age was 35.3 +/- 8.8 yr. All patients had at least four other organ manifestations of vasculitis, either in their history or during the period of lung involvement. The main complaint was hemoptysis of varying degree in 11 of the 12 patients. The chest X-ray films showed unilateral hilar enlargements in six patients, diaphragm elevation in four, horizontally or obliquely oriented linear opacities in three, diffuse, ill-defined infiltrates in upper and lower zones in three, wedge-shaped peripheral opacities in one, and bilateral pleural effusion in one patient. Computed tomography of the chest performed in nine patients revealed aneurysms, narrowings, and cutoffs of the main, lobar, segmental, or peripheral branches of the pulmonary artery and irregular configuration of other pulmonary vessels. Perfusion scans demonstrated defects of various sizes in all patients. Pulmonary angiography performed in only two patients showed amputation of branches of the pulmonary artery and aneurysmal dilatations. The patients were treated with a combination therapy consisting of corticosteroid, cyclophosphamide, colchicine, and antiaggregants, with very good results in the short term.
Collapse
Affiliation(s)
- F Erkan
- Department of Pneumology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
| | | |
Collapse
|
10
|
Lang BA, Laxer RM, Thorner P, Greenberg M, Silverman ED. Pediatric onset of Behçet's syndrome with myositis: case report and literature review illustrating unusual features. ARTHRITIS AND RHEUMATISM 1990; 33:418-25. [PMID: 2180406 DOI: 10.1002/art.1780330317] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of Behçet's syndrome with myositis in a pediatric patient, emphasizing the importance of muscle involvement in the differential diagnosis of calf pain and swelling in Behçet's syndrome. A review of the English-language literature from 1965 to the present suggests that the clinical picture of Behçet's syndrome in children differs from that in adults, in that there is a lower frequency of ocular disease, and unusual manifestations appear to be more common.
Collapse
Affiliation(s)
- B A Lang
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
11
|
Furukawa T, Hisao O, Furuta S, Shigematsu H. Henoch-Schönlein purpura with nephritis in a patient with Behçet's disease. Am J Kidney Dis 1989; 13:497-500. [PMID: 2729270 DOI: 10.1016/s0272-6386(89)80008-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Recently there have been some case reports of Behçet's disease associated with renal lesions. We describe a patient with Behçet's disease who developed Henoch-Schönlein purpura with nephritis. To our knowledge, this is the first such case to be reported.
Collapse
Affiliation(s)
- T Furukawa
- Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | |
Collapse
|
12
|
Abstract
Among 72 patients with Behçet's syndrome, seven had pulmonary vascular involvement. Additional data from 42 cases in the literature are discussed. Recurrent episodes of dyspnea, cough, chest pain, and hemoptysis were the primary clinical signs, mainly in young men, appearing 3.6 years after the first manifestation of Behçet's syndrome. Fever, elevated ESR, and anemia were common, and chest x-ray films showed pulmonary infiltrates, pleural effusions, and prominent pulmonary arteries. Ventilation-perfusion scans showed perfusion defects even when chest x-ray films were normal. Pulmonary artery aneurysms were seen in 7/13 in whom angiography was done. Of 42 patients, 16 died, 15 from fatal pulmonary hemorrhage, 80 percent within two years from the development of pulmonary disease. Histopathologic study results showed vasculitis of pulmonary vessels of various sizes, leading to thrombosis, destruction of the elastic laminae, aneurysms, and arteriobronchial fistula. In addition, pulmonary emboli and the aphthous lesion of the tracheobronchial tree may aid the clinical picture. Anticoagulant therapy may be hazardous in patients with aneurysmal dilatation of the pulmonary vascular tree, and the beneficial effect of corticosteroid therapy is discussed. Pulmonary vasculitis in Behçet's syndrome is a unique clinical and pathologic picture, differing from other vasculitides affecting the lung, presents a major threat to the patient's life.
Collapse
Affiliation(s)
- I Raz
- Department of Medicine B, Hadassah University Hospital, Jerusalem, Israel
| | | | | |
Collapse
|
13
|
Dilşen N, Koniçe M, Aral O, Erbengi T, Uysal V, Koçak N, Ozdogan E. Behçet's disease associated with amyloidosis in Turkey and in the world. Ann Rheum Dis 1988; 47:157-63. [PMID: 3281606 PMCID: PMC1003469 DOI: 10.1136/ard.47.2.157] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The association of amyloidosis with Behçet's disease has infrequently been reported in published works. Twenty four such cases have been observed in the world, of which 12 are from Turkey, including eight of ours. In all our eight cases renal biopsy showed amyloidosis of type AA. Behçet's disease of male preponderance, long duration, complete type, multiple organ involvement, and positive skin pathergy test were the main characteristics of all 24 cases of Behçet's disease with amyloidosis. We conclude that amyloidosis associated with Behçet's disease is a secondary AA amyloidosis occurring as an intrinsic manifestation of Behçet's disease.
Collapse
Affiliation(s)
- N Dilşen
- Division of Rheumatology, Istanbul Faculty of Medicine, University of Istanbul, Capa
| | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Chiba M, Inoue Y, Arakawa H, Masamune O, Ohkubo M. Behçet's disease associated with amyloidosis. GASTROENTEROLOGIA JAPONICA 1987; 22:487-95. [PMID: 3311868 DOI: 10.1007/bf02773818] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of Behçet's disease associated with amyloidosis is reported. A 34 year-old woman was referred to our Department after suffering diarrhea for one month. She had the complete type of Behçet's disease which began development when she was 12 years old. Diarrhea disappeared after she was admitted to the hospital but stool occult blood was strongly positive. A barium enema revealed the disappearance of haustration in the left colon. Urinalysis was normal. She suffered from cholecystolithiasis, and a cholecystectomy was performed. A histopathological examination revealed amyloid deposits in the stomach, duodenum, large bowel, gallbladder, and kidney. Amyloid was indicated as AA type after treating kidney and colon sections with potassium permanganate. Upon discharge, she was free of symptoms. Up to the present time, 19 cases, including our case of Behçet's disease with amyloidosis, have been reported. Four cases in Japan have been reported in Japanese. Reviewing the 19 cases, however, all of them developed initially as Behçet's disease, followed by amyloidosis and there have only been three cases including ours where the type of amyloid was studied. Our finding was identical to the previous two reports; namely identification of the AA type which is common in secondary amyloidosis. These findings lead to a conclusion that amyloidosis associated with Behçet's disease is secondary.
Collapse
Affiliation(s)
- M Chiba
- First Department of Internal Medicine, Akita University School of Medicine, Japan
| | | | | | | | | |
Collapse
|
16
|
Wechsler B, Le Thi Huong DU, Hamza M, Beaufils H, Godeau P, Chomette G. [Renal and digestive amyloidosis and Behçet's disease. Apropos of a case]. Rev Med Interne 1986; 7:361-4. [PMID: 3797868 DOI: 10.1016/s0248-8663(86)80124-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors report the case of a 33-year old male Tunisian who, 7 years after the onset of complete Behçet's disease (diagnosed on international criteria) developed a nephrotic syndrome diagnosed as renal amyloidosis on histological evidence. Attenuation of Congo red staining by potassium permanganate pointed to AA type amyloidosis. Despite treatment with colchicine and cyclophosphamide the patient's condition deteriorated. Amyloid deposits were found in a small bowel biopsy performed for persistent diarrhoea. The patient died 3 years after amyloidosis was diagnosed. The authors have reviewed the literature concerning this exceptional association: in all cases where it was typed the amyloidosis was AA. Attention is drawn to the failure of colchicine in this patient.
Collapse
|
17
|
Mousa AR, Marafie AA, Rifai KM, Dajani AI, Mukhtar MM. Behçet's disease in Kuwait, Arabia. A report of 29 cases and a review. Scand J Rheumatol 1986; 15:310-32. [PMID: 3798048 DOI: 10.3109/03009748609092599] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-nine patients with Behçet's disease were studied. Of these, 17 patients were followed up for a mean duration of 37 months and 12 for a mean of 18 months. Male to female ratio was 3.1:1. Of the 29 patients, 26 were Arab, 2 Asian and 1 Black African. The prevalence in the country was 2.1:100,000 population, in Kuwaitis 1.58:100,000, in non-Kuwaiti Arabs, 2.9:100,000 and in non-Arabs, 1.35:100,000 population. The frequencies of the various manifestations were: oral ulcers, 100%; genital ulcers, 93%; skin manifestations, 76%; arthropathy and ocular disease, 69% each; psychiatric disorders, 38%; vascular complications and positive Pathergy test, 34% each; gastrointestinal symptoms, 21%; oesophageal and CNS involvement, 14% each; and peritonism, renal and pulmonary involvement, 7% each. Kuwaiti bedouins seemed to be resistant to the disease, probably due to environmental and/or dietary factors. The hot arid climate of the Gulf had no effect on the course of the disease once it had developed.
Collapse
|
18
|
Lakhanpal S, Tani K, Lie JT, Katoh K, Ishigatsubo Y, Ohokubo T. Pathologic features of Behçet's syndrome: a review of Japanese autopsy registry data. Hum Pathol 1985; 16:790-5. [PMID: 4018777 DOI: 10.1016/s0046-8177(85)80250-1] [Citation(s) in RCA: 240] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The data recorded from 170 autopsies of patients with Behçet's syndrome in Japan during the period from 1961 to 1976 were analyzed. The patients had been in the second to the eighth decade of life, and the ratio of males to females was 5 to 2. A wide spectrum of pathologic findings was observed, with involvement of neurologic, ophthalmic, cardiovascular, pulmonary, gastrointestinal, visceral, genitourinary, and mucocutaneous systems. Some of the common acknowledged clinical features of the syndrome, such as oral ulcers, synovitis, retinal and cutaneous vasculitis, and venous occlusions, were underreported. This apparent discrepancy in an autopsy series may be due to the effects of treatment or the healing process, as well as to the possible incompleteness of the postmortem examination. The accessibility of recorded data in a national autopsy registry offers a unique opportunity for review of the pathologic features of Behçet's syndrome.
Collapse
|
19
|
Wilkey D, Yocum DE, Oberley TD, Sundstrom WR, Karl L. Budd-Chiari syndrome and renal failure in Behcet disease. Report of a case and review of the literature. Am J Med 1983; 75:541-50. [PMID: 6351612 DOI: 10.1016/0002-9343(83)90364-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A case of Behcet syndrome associated with three rare complications is presented. The patient initially presented with asymmetric polyarticular arthritis, subcutaneous nodules, conjunctivitis, and episcleritis. Necrotizing vasculitis and renal failure subsequently evolved. Despite immunosuppressive therapy, Budd-Chiari syndrome with high grade hepatic obstruction developed. A Denver shunt procedure failed to alter the terminal course. At postmortem examination, skin lesions, carditis, hepatic vein thrombosis, gastric ulcerations, and focal proliferative glomerulonephritis were found. The immunoglobulins and complement present in skin and renal tissue suggest an immune complex pathogenesis.
Collapse
|
20
|
Herreman G, Beaufils H, Godeau P, Cassou B, Wechsler B, Boujeau J, Chomette G. Behcet's syndrome and renal involvement: a histological and immunofluorescent study of eleven renal biopsies. Am J Med Sci 1982; 284:10-7. [PMID: 6211982 DOI: 10.1097/00000441-198207000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The finding of focal glomerulonephritis in a patient with Behcet's syndrome led us to perform systematic renal biopsies in ten other patients with the disease. None of the patients had symptoms of renal disease. Proteinuria was found in five, two of whom had associated leukocyturia. By light microscopy mesangial and extramembranous glomerular deposits were observed in eight patients. Arterioles in ten patients showed subendothelial and medial hyaline deposits. A granular pattern of fluorescent staining identified the presence of the third component of complement in these deposits. Circulating immune deposits were sought and found in six out of seven patients. The finding of circulating immune complexes and deposition of complement in glomerular and arteriolar tissues supports an immune complex mediated nephropathy and is consistent with the hypothesis of an immunological pathogenesis in Behcet's syndrome.
Collapse
|
21
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1982. Recent onset of proteinuria in a young woman with a chronic, multisystemic disease. N Engl J Med 1982; 306:1162-7. [PMID: 7070420 DOI: 10.1056/nejm198205133061907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
22
|
|
23
|
|
24
|
Beaufils H, Cassou B, Auriol M, Herreman G, Wechsler B, Roujeau JC, Godeau P, Chomette G. Kidney involvement in Behçet's syndrome. A report of 11 cases studied by optic, ultrastructural and immunopathological techniques. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1980; 388:187-98. [PMID: 7010772 DOI: 10.1007/bf00430687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
25
|
O'Connell DJ, Courtney JV, Riddell RH. Colitis of Behçet's syndrome--radiologic and pathologic features. GASTROINTESTINAL RADIOLOGY 1980; 5:173-9. [PMID: 7380160 DOI: 10.1007/bf01888624] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Three patients with Behçet's syndrome and colitis are described. The radiologic and histologic appearances of the colitis are discussed. The similarities of Behçet's colitis to Crohn's disease are outlined. The cases demonstrate the necessity to consider Behçet's syndrome in the differential diagnosis of inflammatory bowel disease.
Collapse
|
26
|
Abstract
A case of-Behçet's syndrome is described in which, in addition to the usual features of the condition, there was evidence of renal, gastric and cardiac involvement. Neurological involvement presented as hemisphere, transient ischaemic episodes. Immune complexes were detected and the patient responded promptly to prednisolone.
Collapse
|
27
|
Gamble CN, Wiesner KB, Shapiro RF, Boyer WJ. The immune complex pathogenesis of glomerulonephritis and pulmonary vasculitis in Behçet's disease. Am J Med 1979; 66:1031-9. [PMID: 156498 DOI: 10.1016/0002-9343(79)90461-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A kidney and lung biopsy were performed on a patient with active Behçet's disease with renal and pulmonary involvement. Histologic, immunohistochemical and electron microscopic studies of the kidney biopsy specimen revealed a focal segmental necrotizing glomerulonephritis characterized by the presence of numerous subendothelial and occasional intramembranous deposits containing immunoglobulin G (IgG), the third component of complement (C3), the fourth component of complement (C4) and fibrin(ogen). Histologic and immunohistochemical studies of the lung biopsy specimen showed an acute venulitis and septal capillaritis associated with the presence of identical deposits within the walls of affected vessels. Circulating immune complexes were detected in the patient's serum by Raji cell assay. The findings indicate that the glomerulonephritis and pulmonary vasculitis occasionally occurring in Behçet's disease are due to the deposition of circulating antigen-antibody complexes. In addition, they strongly suggest that the majority of the major and minor manifestations of the disease, such as uveitis, cutaneous vasculitis, synovitis and meningoencephalitis, are a result of vascular immune complex deposition.
Collapse
|
28
|
|