Behcet disease: an undifferentiating and complex vasculitis

Behçet's Disease, Pathogenesis, Clinical Features, and Treatment Approaches: A Comprehensive Review

Behçet's disease is a systemic inflammatory disorder of unknown etiology. The disease manifests with diverse clinical symptoms, most commonly recurrent oral and genital ulcers, skin lesions, and uveitis, though it can affect multiple organ systems. Diagnosis is primarily clinical due to the lack of a definitive diagnostic test, and management involves a multidisciplinary approach to control inflammation and manage symptoms. Current treatment strategies involve corticosteroids, immunosuppressive agents, and, increasingly, biological therapies. Behçet's disease exhibits a higher prevalence along the Silk Road, suggesting a role of environmental and genetic factors. Despite significant progress in understanding its clinical characteristics and treatment approaches, gaps remain in our understanding of its pathogenesis. Future research is needed to elucidate the disease's pathophysiology and optimize treatment strategies.

Diagnosis of Behcet's disease in a young male patient with acute bilateral pulmonary embolism; A case report and literature review

Behcet's disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is a high rate of deep vein thrombosis in BD, pulmonary arterial thromboembolism (PTE) is a rare complication. We present a 30-year-old patient who was admitted with pleuritic chest pain, non-massive hemoptysis since 4 days ago and medical history of intermittent genial aphthous lesions, and skin lesions. During our evaluation, he had an S1Q3T3 pattern in the electrocardiogram, a high level of D-dimer, a low level of FDP and fibrinogen along with pulmonary emboli in lobar and segmental branches of the right pulmonary artery and segmental branches of left lower lobe pulmonary artery were detected in his pulmonary CT Angiography. Then, he was positive for HLA-B51. Based on his clinical condition and history of recurrent genital and skin lesions, a positive pathergy test. Therefore, the diagnosis of BD was confirmed for him. Diagnosis of PTE can be difficult due to the rarity of PTE in BD and nonspecific clinical symptoms; therefore, a high degree of suspicion and appropriate radiographic imaging is essential for the diagnosis.

Corneal ring infiltrate- far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management

OBJECTIVE

Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist.

METHODS

The PUBMED database was searched for "corneal ring infiltrate" and "ring infiltrate" phrases, "sterile corneal infiltrate" and "corneal infiltrate". We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate.

RESULTS

Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment.

CONCLUSION

Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.

Novel approach to Behçet's disease in the era of biologic agents

PURPOSE

This review aims to provide better understanding of modern modalities to investigate ocular symptoms of Behçet's disease in order to achieve appropriate management protocols and reduce irreversible visual loss.

RELEVANT FINDINGS

Current methods of diagnosing intraocular involvement in Behçet's disease gives clue to early diagnosis. In addition to standard ocular examination and fluorescein angiography, new noninvasive methods include ocular coherence tomography (OCT) and OCT angiography provide early detection of macular and retinal involvement that can be treated early to improve the prognosis.

SUMMARY

Over the last decade, new multimodal imagings are becoming more accessible; therefore, rapid diagnosis can be made. In addition to newer approved biologic agents, ocular Behçet's disease is seen to be in better controlled with fewer complications.

Microbiome in Behcet's syndrome

This review will discuss the current understanding of the role of microbiomes in Behcet's Syndrome, their influence on immune response and disease and potential future studies.