A patient with liver trauma and incomplete behcet s disease

Behcet' s Disease (BD ) is a complex multisystemic disease, which is characterized by recurrent oral and genital aphteous ulcers and iritis in which vasculitis can also be one of the possible clinical manifestations. A thirty seven year-old female patient with incomplete BD was admitted to emergency service, with intra-abdominal hemorrhage more severe than that would be expected, with the degree of related trauma. We decided to manage the patient conservatively, observing vital signs, haemogram, computed tomography (CT) and angiography instead. Subcapsular hematomas were detected in the right and left lobes of the liver. No data was encountered in the literature and textbooks referring to liver trauma with BD, except a case of fatal hemobilia. H ere in we present a liver trauma case with hemorrhage and hepatic fragility due to vasculitis in Behcet' s disease and review the literature. Key words: liver trauma, incomplete Behcet' s disease

Mediastinal mass and brachial plexopathy caused by subclavian arterial aneurysm in Behçet's disease

Vascular involvement in Behçet's disease is divided into venous and arterial thrombosis and arterial aneurysmal formation. Subclavian arterial aneurysm rarely occurs in Behçet's disease; however, when it does occur, it causes serious aneurysmal rupture and local complications such as nerve compression and arterial ischemia. We describe the case of a 39-year-old male who presented with neurologic symptoms and signs of brachial plexopathy and mediastinal mass caused by Behçet's subclavian arterial aneurysm. This case shows that the occurrence of brachial plexopathy should be considered a manifestation of Behçet's disease, and that Behçet's aneurysm should be considered in the differential diagnosis of upper mediastinal mass.

The coexistence of Behçet's disease and ankylosing spondylitis

We present the case of a young woman suffering from both ankylosing spondylitis and Behçet's disease, associated with a severe inflammatory arthritis. Although the HLA phenotype was positive for HLA-B27 and negative for HLA-B5, the clinical findings, especially the joint manifestations of Behçet's disease, seem to appear dominantly. The meaning of this rare combination was discussed with a review of the literature.

Behçet disease

Central nervous system involvement in Behçet disease (BD) may be either parenchymal or nonparenchymal. Abnormal cerebrospinal fluid findings and parenchymal involvement are associated with a poorer prognosis. A self-antigenic role for HLA B51 has been postulated in the pathogenesis of BD. The sibling occurrence rate is 3.6%. Familial aggregation may be more pronounced among pediatric cases compared with adult cases. The importance of inherited coagulation abnormalities in the pathogenesis of BD is not clear. Vasculitis of the vasa vasorum seems to be the major site of pathology in large vessel disease. Even among experts, no consensus exists regarding the optimal approach to treatment. Low-dose thalidomide is effective for the mucocutaneous lesions, but polyneuropathy complicates its prolonged use. Neurologic side effects of cyclosporine A should preclude its use in patients with central nervous system involvement except in unusual circumstances. The heightened inflammatory response of BD patients to simple trauma may lead to postoperative complications, but should not be regarded as a contraindication to surgery.

[Neurologic complications after surgery for subrenal abdominal aorta. Report of a case of Behcet's syndrome]

Medullary ischemia is an uncommon and serious complication of subrenal aortic surgery. It generally occurs after surgery for ruptured aneurysms and second operations on the aorta. We report the case of a 29-year-old patient who had Behçet's disease with multiple arterial complications. The patient underwent emergency surgery for ruptured aneurysm of the abdominal aorta. An aorto-aortic prosthetic graft was implanted. The postoperative period was complicated by paraplegia and thrombosis of the prosthetic graft with dissection of the iliac arteries. The patient was reoperated and an aorto-bifemoral bypass was installed. After two years, the patient has recovered part of his neurological deficiency. The pathogenesis of this complication is well known, but prevention remains a challenge.

[Herpes simplex brainstem encephalitis presenting high intensity area on MRI--a case report]

A case of herpes simplex encephalitis with high signal intensity area in brainstem on MRI was presented. A 44 year-old woman suffered from oral aphthous ulcerations in the end of 1988, and then it improved naturally. Oral aphtha appeared again on February 1988 followed by resistant fever to antibiotics and right hemiparesis. She was admitted to our hospital on 25 February 1988. Neurological examination revealed mild consciousness disturbance, neck stiffness, right-side deviation of tongue with dysarthria and right hemiparesis with bilateral plantar extensor reflex. Right hemisensory deficit in all modalities and truncal ataxia was also detected. Some aphthous ulcerations were revealed in oral cavity, but there were no ulcers on genitalia nor uveitis. CSF showed 32 mononuclear cells/mm3, protein 52 mg/dl and glucose 97 mg/dl. CSF culture and india ink stain, and serum autoantibodies were all negative. EEG and CT scan with contrast enhancement showed no significant abnormalities. T2-weighted brain MRI revealed high intensity area in the center of the pons. Anti-herpes simplex virus (HSV) type I antibody titer (FA method) in both serum and CSF were highly positive. Neurological symptoms gradually improved on the therapy of aciclovir and adrenal cortico-steroid. High intensity area in the pons on MRI was also gradually reduced. In this case, complete diagnostic differentiation from neuro-Behçet disease was difficult, but this case did not meet its diagnostic criteria. From the change of anti-HSV antibody titer both in serum and CSF, we diagnosed this case HSV brainstem encephalitis presenting high intensity area in the pons on MRI which has never been reported.