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Nadia BA, Ahmed M, Mhamdi T, Hechemi M, Leila K, Fethi K. Co-occurrence of Behçet disease with Ig A vasculitis revealed by ophtalmic examination: A case report. Ann Med Surg (Lond) 2021; 66:102446. [PMID: 34158929 PMCID: PMC8203717 DOI: 10.1016/j.amsu.2021.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Renal involvment of Behçet disease is not usual and Ig A vasculitis complicated by Behçet disease is extremely rare. Case presentation We report a case of Henoch Scholein purpura and nephritis associated with Behçet disease revealed by ophthalmic examination. Clinical discussion Recurrent oral ulcer is not a manifestation of Ig A vasculitis which doesn't affect large or middle sized arteries. If the patient had'nt been referred to our department for ophthalmic examination, we may have failed to make the diagnosis and treat coexisting Behçet disease. Conclusion The link of HSP and BD has yet to be fully understood, and more researchisdefinitelyneeded. The renal involvement is not verycommon in Behçet disease. Studies have shown a correlation between certain human leukocyte antigens (HLA) and renal involvment in Behçet disease. Ig A vasculitis complicated by Behçet disease is extremely rare. The link of HSP and BD has yet to be fully understood, and more researchisdefinitelyneeded.
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Affiliation(s)
| | - Mahjoub Ahmed
- Ophthalmology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Tasnim Mhamdi
- Ophthalmology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Mahjoub Hechemi
- Ophthalmology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Knani Leila
- Ophthalmology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Krifa Fethi
- Ophthalmology Department, Farhat Hached Hospital, Sousse, Tunisia
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Higashihara T, Okada A, Kusano T, Ishigaki K, Shimizu A, Takano H. A novel case of renal pathergy reaction in a Behçet's disease patient complicated by IgA vasculitis. BMC Nephrol 2017; 18:40. [PMID: 28129738 PMCID: PMC5273836 DOI: 10.1186/s12882-017-0451-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A pathergy reaction is defined as a hyperreactivity of the skin in response to minimal trauma, which is important in the diagnosis of Behçet's disease (BD). However, a pathergy reaction may not be restricted to the skin, and little is known about whether an invasive medical procedure can induce the reaction. Here we present a pathergy reaction induced by renal biopsy, an invasive procedure. CASE PRESENTATION A 46-year-old man who was diagnosed with IgA vasculitis (IgAV) at the age of 38 was treated with prednisolone and mizoribine. However, complications such as common carotid arteritis or recurrent oral ulcer suggested the possibility of another pathophysiology. Later, increasing urine protein developed, suggesting disease aggravation. However, renal biopsy showed arteriosclerotic changes caused mainly by hypertension, negating exacerbation. After renal biopsy, his renal dysfunction and body temperature fluctuated, and detailed examinations revealed recurrent oral and genital ulcers and a folliculitis-like rash on his scrotum. Later, he complained of myodesopsia caused by hemorrhage in the ocular fundus due to occlusive vasculitis. Complete BD was diagnosed after development of the symptoms, and he was treated with prednisolone and colchicine. CONCLUSION Co-occurrence of BD with IgAV is very rare and may be associated with immune disorders. Interestingly, a renal biopsy revealed BD, which was masked by the presence of IgAV, and elucidated the etiology of the unexplainable symptoms. To the best of our knowledge, this is the first report of renal pathergy. This case enlightens clinicians to the fact that not only a needle stimulation but also an invasive procedure can cause a pathergy reaction.
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Affiliation(s)
- Takaaki Higashihara
- Department of Nephrology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, 102-8798, Tokyo, Japan
| | - Akira Okada
- Department of Nephrology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, 102-8798, Tokyo, Japan. .,Divison of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
| | - Taiko Kusano
- Department of Nephrology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, 102-8798, Tokyo, Japan
| | - Kazuyoshi Ishigaki
- Department of Allergy and Rheumatology, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
| | - Hideki Takano
- Department of Nephrology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, 102-8798, Tokyo, Japan
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Ryu YS, Jeon CH, Jin SY. A Case of Behcet's Disease Complicated by IgA Nephropathy. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.4.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yang Seon Ryu
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - So Young Jin
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Korea
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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.
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Affiliation(s)
- Tekin Akpolat
- Ondokuz Mayis University School of Medicine, Samsun-Turkey.
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Gazit D, Nahlieli O, Neder A, Berstein I, Ulmansky M. Leukocytoclastic vasculitis (anaphylactoid purpura): a unique occurrence in the oral cavity. J Oral Pathol Med 1991; 20:509-11. [PMID: 1753354 DOI: 10.1111/j.1600-0714.1991.tb00414.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Leukocytoclastic vasculitis, immune complex disorder (type III), is a skin disease with both an acute form characterized by bullae, vesicles and ulcerations, and a chronic form characterized by petechiae, macules and ulcerations. The disease presents certain systemic features including diffuse or focal glomerulonephritis and renal failure. The histopathologic characteristics of leukocytoclastic vasculitis in the skin appear primarily in small blood vessels and consist of an infiltration of inflammatory cells, leukoclasis, swelling of endothelial cells, occlusion of blood vessels, accumulation of fibrin and fibrinoid degeneration, as well as the presence of immune complexes in and around blood vessel walls. Although leukocytoclastic vasculitis is described as several diseases which can spread systemically, including the gastrointestinal tract and the kidneys, the manifestations of the disease in the oral cavity have not yet been reported. The present paper reports unique oral lesions in a 38-yr-old woman, diagnosed as leukocytoclastic vasculitis, without any accompanying skin or systemic lesions.
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Affiliation(s)
- D Gazit
- Division of Oral Pathology, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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