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Demotier S, Orquevaux P, N’Guyen Y. Systemic vasculitis diagnosed during the post-partum period: case report and review of the literature. Matern Health Neonatol Perinatol 2023; 9:2. [PMID: 36755295 PMCID: PMC9906945 DOI: 10.1186/s40748-023-00147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The vasculitis diagnosed specifically in the post-partum period are less well known. We report here such a case followed by a descriptive review of the literature. CASE REPORT A 25 year-old French nurse reported abrupt-onset musculoskeletal pain 15 days after delivery of her first infant. Her first pregnancy was uneventful. The physical examination yielded only bilateral conjunctivitis and purpuric eruption of lower limbs, and complementary investigations evidenced pulmonary renal syndrome in connection with the diagnosis of Granulomatosis with Polyangiitis. METHODS We screened previous articles in Medline database using keywords (i) "post-partum" or "puerperium" (ii)"peripartum" (iii) "pregnancy" associated with "vasculitis". Full texts were obtained from case reports or cases series whose title or abstract included keywords of interest (or synonyms). These references were secondarily excluded if the diagnosis of vasculitis was not confirmed or made before or more than 6 months after delivery and if vasculitis occurred only in the new born or affected only the cerebral vasculature or the retina. RESULTS Fifty-six cases of vasculitis diagnosed in the post-partum period were included, 50 (89.3%) were secondary to an immunological process and 44 corresponded to primary vasculitis, 4 were secondary to Systemic Lupus Erythematosus, 1 to cryoglobulinaemia and 1 to cryoglobulinaemia associated with inflammatory bowel disease. The main primary vasculitis diagnosed were Takayasu Arteritis (n = 10), Eosinophilic granulomatosis with polyangiitis (n = 9), Granulomatosis with Polyangiitis (n = 7), Periarteritis Nodosa (n = 5) and Behcet's disease (n = 4). The first symptom occurred before delivery in 26 (59.1%) and maternal death occurred in 4 (9.1%) out of the 44 primary vasculitis cases. CONCLUSION The vasculitis diagnosed in the post-partum period were mainly primary vasculitis among patients in whom the diagnosis had not been made during pregnancy. In less than half of cases and as described in ours, there were no reported symptoms before delivery. Therefore, the physicians should pay attention to symptoms and keep a high degree of suspicion for vasculitis before as well as after delivery.
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Affiliation(s)
- Sophie Demotier
- grid.139510.f0000 0004 0472 3476Service de Médecine Interne, Maladies Infectieuses Et Immunologie Clinique. Hôpital Robert Debré. Centre Hospitalier Universitaire Reims, 51100 Reims, France
| | - Pauline Orquevaux
- grid.139510.f0000 0004 0472 3476Service de Médecine Interne, Maladies Infectieuses Et Immunologie Clinique. Hôpital Robert Debré. Centre Hospitalier Universitaire Reims, 51100 Reims, France
| | - Yohan N’Guyen
- grid.139510.f0000 0004 0472 3476Service de Médecine Interne, Maladies Infectieuses Et Immunologie Clinique. Hôpital Robert Debré. Centre Hospitalier Universitaire Reims, 51100 Reims, France
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Abstract
Purpose of Review In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides. Recent Findings Successful pregnancies in patients with vasculitides are possible, especially when conception is planned, and the disease is in remission. The risk of vasculitis flare is highly dependent on the type of vasculitis, but overall limited. The most frequent complication associated with large-vessel vasculitis (mainly Takayasu arteritis) is hypertension and preeclampsia. Preterm deliveries and intrauterine growth restriction occur more frequently with small- and medium-vessel vasculitis. Summary Pregnancies in patients with vasculitis should be considered high risk and followed by a multidisciplinary team with expertise in the field. Flares should be managed as in the non-pregnant population, while avoiding medications with unknown safety in pregnancy or known teratogens. Although commonly prescribed for the prevention of preeclampsia, there is limited evidence supporting the use of low-dose aspirin for pregnant women with vasculitis. Prospective registries or studies are needed, to better assess the value of aspirin, the place and long-term impact of new biologics and, to identify predictors of pregnancy outcomes other than disease status at conception.
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Affiliation(s)
- Carolyn Ross
- Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Christian Pagnoux
- Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Merlino L, Del Prete F, Lobozzo B, Priori R, Piccioni MG. Behcet's disease and pregnancy: a systematic review. ACTA ACUST UNITED AC 2020; 72:332-338. [PMID: 32403914 DOI: 10.23736/s0026-4784.20.04564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Behcet's disease (BD) is a rare inflammatory, multisystemic, autoimmune disorder with unknown origin. BD is included in vasculitic disorders with a more frequent onset characterized by oral and genital ulcers associated with eye inflammation. However, BD has several clinical manifestations, and the most fearful complication is thrombotic involvement. BD occurs mainly in women of childbearing age, therefore it is important to identify the potential risks of pregnancy on the mother and fetus. EVIDENCE ACQUISITION The aim of our review is to identify, through the study of existing literature, the possible consequences of pregnancy on the course of this disease, the potential risks for the mother and fetus in gestation period and in puerperium, in order to identify a correct pregnancy management in patient affected by BD. EVIDENCE SYNTHESIS Currently, there are few studies that have analyzed the consequences of the disease on the course of pregnancy and pregnancy on the activity of the pathology. Some authors believe that pregnancy may worsen the symptoms of the disease, while others may even improve the course. Many authors believe that thromboembolic events are the main problems for which focus attention on these patients, both in pregnancy and in puerperium. Different opinions exist about pregnancy complications and neonatal outcomes, although events such as abortion, intrauterine growth restriction and C-section appear to have a higher incidence in BD patients. CONCLUSIONS There are no contraindications for the onset of pregnancy in BD patients. In most cases pregnancy can improve the course of the disease. However, in view of the potential adverse events, a thorough follow-up of the pregnancy is necessary in order to minimize any risks to the mother and fetus.
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Affiliation(s)
- Lucia Merlino
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Federica Del Prete
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy -
| | - Benedetta Lobozzo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Roberta Priori
- Unit of Rheumatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
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Lee S, Czuzoj-Shulman N, Abenhaim HA. Behcet's disease and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 12 million births. J Perinat Med 2019; 47:381-387. [PMID: 30763266 DOI: 10.1515/jpm-2018-0161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/09/2019] [Indexed: 01/29/2023]
Abstract
Background Behcet's disease (BD) is a rare, multi-systemic inflammatory disorder for which only limited and contradictory data exists in the context of pregnancy. Our objective was to estimate the prevalence of BD in pregnancy and to evaluate maternal and fetal outcomes associated with pregnant women living with BD. Methods Using the 1999-2013 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States, we performed a population-based retrospective cohort study consisting of pregnancies that occurred during this time period. ICD-9 codes were used to identify delivery admissions to women with or without BD. Multivariate logistic regression was used to estimate the adjusted effects of BD on maternal and fetal outcomes. Results Among the 12,592,676 pregnancies in our cohort, 144 were to women with BD, for an overall prevalence of 1.14 cases/100,000 births between 1999 and 2013. Over the study period, the prevalence of BD rose from 0.5 to 2.4/100,000 births. Women with BD demonstrated a two-fold greater frequency of non-delivery hospital admissions during pregnancy, and were more likely to be Caucasian, have private medical insurance, be of the upper income quartiles, and deliver at an urban teaching hospital. Women with BD were at greater risk for preterm labor and postpartum venous thromboembolism, while their newborns were more likely to be born premature. Conclusion BD-associated pregnancies are increasing in prevalence and are associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism.
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Affiliation(s)
- Seohyuk Lee
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
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5
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Non-vitamin K antagonist oral anticoagulants for the treatment of intracardiac thrombosis. J Thromb Thrombolysis 2018; 46:332-338. [DOI: 10.1007/s11239-018-1693-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Hijazi EM, Ibdah RK, Rawashdeh SI, Saadeh AM, Al-Balas HI. Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet's Disease - From Cardiac Surgical Point of View. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:412-6. [PMID: 27311379 PMCID: PMC4917071 DOI: 10.12659/ajcr.897998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 27 Final Diagnosis: Right atrial thrombus compressing the sinoatrial node Symptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizziness Medication: — Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safely Specialty: Surgery
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Affiliation(s)
- Emad Mohamed Hijazi
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Rasheed Khaled Ibdah
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Sukina Ismael Rawashdeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Abdullah Mahmoud Saadeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology,, Irbid, Jordan
| | - Hamzeh Ibrahim Al-Balas
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
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Xu C, Bao S. Behcet's disease and pregnancy-a case report and literature review. Am J Reprod Immunol 2016; 77. [PMID: 27296674 DOI: 10.1111/aji.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Chuanlu Xu
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital; Tongji University School of Medicine; Shanghai China
| | - Shihua Bao
- Department of Reproductive Immunology; Shanghai First Maternity and Infant Hospital; Tongji University School of Medicine; Shanghai China
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Lisitsyna T, Alekberova Z, Ovcharov P, Volkov A, Korsakova J, Nasonov E. Left ventricular intracardiac thrombus in a patient with Behçet disease successfully treated with immunosuppressive agents without anticoagulation: a case report and review of the literature. Rheumatol Int 2015; 35:1931-5. [PMID: 26055535 DOI: 10.1007/s00296-015-3306-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/01/2015] [Indexed: 01/29/2023]
Abstract
Behçet disease (BD) is a chronic multisystem disorder with vasculitis underlying its systemic manifestations. Cardiac involvement and particularly left ventricular intracardiac thrombus are rarely diagnosed in the course of BD and are often associated with poor prognosis. The causes of intracardiac thrombi are unknown. It is plausible that specific proinflammatory pathways resulting in the endothelial cell injury and hypercoagulation contribute to the formation of thrombotic masses in the heart. Known thrombophilic factors such as methylenetetrahydrofolate reductase gene mutations, factor V Leiden mutation, proteins S and C, antithrombin III, activated protein C resistance, and antiphospholipid antibodies may contribute to the formation of intracardiac thrombi in BD. We report a case of a 24-year-old male patient with BD presented with left ventricular thrombus. Transthoracic echocardiography allowed to describe and monitor such a rare cardiac manifestation of the disease. A combination of high-dose corticosteroid and azathioprine successfully dissolved intracardiac thrombus within ten days without anticoagulation.
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Affiliation(s)
- Tatiana Lisitsyna
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Zemfira Alekberova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Pavel Ovcharov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Alexander Volkov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Julia Korsakova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Evgeni Nasonov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
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Gomes V, Mesquita A, Capela C. Autoimmune diseases and pregnancy: analysis of a series of cases. BMC Res Notes 2015; 8:216. [PMID: 26040452 PMCID: PMC4467633 DOI: 10.1186/s13104-015-1177-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/19/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An autoimmune disease is characterized by tissue damage, caused by self-reactivity of different effector mechanisms of the immune system, namely antibodies and T cells. All autoimmune diseases, to some extent, have implications for fertility and obstetrics. Currently, due to available treatments and specialised care for pregnant women with autoimmune disease, the prognosis for both mother and child has improved significantly. However these pregnancies are always high risk. The purpose of this study is to analyse the fertility/pregnancy process of women with systemic and organ-specific autoimmune diseases and assess pathological and treatment implications. METHODS The authors performed an analysis of the clinical records and relevant obstetric history of five patients representing five distinct autoimmune pathological scenarios, selected from Autoimmune Disease Consultation at the Hospital of Braga, and reviewed the literature. RESULTS The five clinical cases are the following: Case 1-28 years old with systemic lupus erythematosus, and clinical remission of the disease, under medication with hydroxychloroquine, prednisolone and acetylsalicylic acid, with incomplete miscarriage at 7 weeks of gestation without signs of thrombosis. Case 2-44 years old with history of two late miscarriages, a single preterm delivery (33 weeks) and multiple thrombotic events over the years, was diagnosed with antiphospholipid syndrome after acute myocardial infarction. Case 3-31 years old with polymyositis, treated with azathioprine for 3 years with complete remission of the disease, took the informed decision to get pregnant after medical consultation and full weaning from azathioprine, and gave birth to a healthy term new-born. Case 4-38 years old pregnant woman developed Behcet's syndrome during the final 15 weeks of gestation and with disease exacerbation after delivery. Case 5-36 years old with autoimmune thyroiditis diagnosed during her first pregnancy, with difficult control over the thyroid function over the years and first trimester miscarriage, suffered a second miscarriage despite clinical stability and antibody regression. CONCLUSIONS As described in literature, the authors found a strong association between autoimmune disease and obstetric complications, especially with systemic lupus erythematosus, antiphospholipid syndrome and autoimmune thyroiditis.
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Affiliation(s)
- Vânia Gomes
- Autoimmune Disease Unit, Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
| | - Alexandra Mesquita
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal.
| | - Carlos Capela
- Autoimmune Disease Unit, Department of Internal Medicine, Hospital of Braga, Braga, Portugal. .,Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal.
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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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11
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Eldin AB, Ibrahim A. Assessment of the relationship between vascular endothelial growth factor and cardiovascular involvement in Egyptian patients with Behçet’s disease. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Noel N, Wechsler B, Nizard J, Costedoat-Chalumeau N, Boutin DLTH, Dommergues M, Vauthier-Brouzes D, Cacoub P, Saadoun D. Behçet's Disease and Pregnancy. ACTA ACUST UNITED AC 2013; 65:2450-6. [DOI: 10.1002/art.38052] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/04/2013] [Indexed: 01/28/2023]
Affiliation(s)
- Nicolas Noel
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Bertrand Wechsler
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Jacky Nizard
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | | | - Du Le Thi Huong Boutin
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Marc Dommergues
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Danièle Vauthier-Brouzes
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - David Saadoun
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
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Düzgün N, Küçükşahin O, Atasoy KÇ, Togay Işıkay C, Gerede DM, Erden A, Şahap SK, İbiş MA, Ateş A. Behçet's Disease and Intracardiac Thrombosis: A Report of Three Cases. Case Rep Rheumatol 2013; 2013:637015. [PMID: 23936717 PMCID: PMC3713602 DOI: 10.1155/2013/637015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/14/2013] [Indexed: 11/18/2022] Open
Abstract
We present three patients with Behçet's disease associated with intracardiac thrombus and pulmonary vascular involvement. One of these patients had also Budd-Chiari syndrome. All patients were treated with corticosteroid plus monthly intravenous cyclophosphamide as first line treatment and with no recurrences. Immunosuppressive therapy was successful in the treatment of intracardiac thrombus and also in the regression of pulmonary vascular thromboses in these patients. Intracardiac thrombus in Behçet's disease is rarely seen. Behçet's disease should be remembered in the differential diagnosis of the patients with intracardiac mass, especially in patients from the Mediterranean and Middle East populations.
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Affiliation(s)
- Nurşen Düzgün
- Department of Internal Medicine-Rheumatology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Orhan Küçükşahin
- Department of Internal Medicine-Rheumatology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Kayhan Çetin Atasoy
- Department of Radiology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Canan Togay Işıkay
- Department of Neurology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Demet Menekşe Gerede
- Department of Cardiology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Radiology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Muhammed Arif İbiş
- Department of Internal Medicine, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
| | - Aşkın Ateş
- Department of Internal Medicine-Rheumatology, Ankara University, Faculty of Medicine, Akademik Yerleşke, Sıhhıye, 06100 Ankara, Turkey
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Tang AW, Greer I. A systematic review on the use of new anticoagulants in pregnancy. Obstet Med 2013; 6:64-71. [PMID: 27757159 DOI: 10.1177/1753495x12472642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/17/2022] Open
Abstract
New anticoagulants such as direct factor Xa inhibitors and direct thrombin inhibitors have been recently developed, but their experience in pregnancy is limited. This review therefore aims to systematically search for studies on the use of these newer anticoagulants in pregnancy and the puerperal period. Searches were performed on electronic databases MEDLINE (from 1966), EMBASE (from 1974) and the Cochrane Library, until October 2011 using terms of 'pregnancy', 'puerperium', 'breastfeeding' and names of specific anticoagulants. The search yielded 561 citations and 11 studies (10 on fondaparinux, 1 on ximelagatran) were included. Newer anticoagulants (fondaparinux, hirudin and argatroban) on the limited evidence appear not to have adverse pregnancy outcomes, but there is currently no experience of new oral anticoagulants (rivaroxaban, apixaban, betrixaban or dabigatran) use in pregnancy. There is a need for reporting on new oral anticoagulation use in pregnancy to provide more information about the safety and risks to the fetus in utero.
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Affiliation(s)
- Ai-Wei Tang
- Fetal Medicine Unit, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, UK
| | - Ian Greer
- Faculty of Health & Life Sciences, University of Liverpool, Foundation Building, Liverpool L69 7ZX, UK
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Margulescu AD, Fraser AG. Resolution of left ventricular thrombus with lepirudin after failed treatment with heparin. Am J Emerg Med 2012; 30:1015.e3-5. [DOI: 10.1016/j.ajem.2011.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022] Open
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Gatto M, Iaccarino L, Canova M, Zen M, Nalotto L, Ramonda R, Punzi L, Doria A. Pregnancy and vasculitis: A systematic review of the literature. Autoimmun Rev 2012; 11:A447-59. [DOI: 10.1016/j.autrev.2011.11.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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