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Lalouly S, El Kaoua O, Chettati M, Fadili W, Laouad I. Multiple Venous Thromboses and Renal Failure in Behcet's Disease: A Case Report and Review of the Literature. Cureus 2024; 16:e57560. [PMID: 38707126 PMCID: PMC11068658 DOI: 10.7759/cureus.57560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Behcet's disease (BD) is a systemic condition of unknown etiology, characterized by a wide clinical polymorphism. Vascular involvement in BD is rare and can be revealing in many cases. We present an advanced case of BD with multiple venous thromboses associated with urgent dialysis-dependent end-stage chronic renal failure. This case highlights the complexity of managing BD, emphasizing the challenges associated with multiple thromboses and the crucial importance of early diagnosis to optimize the management of this systemic disease.
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Affiliation(s)
- Sara Lalouly
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Mohammed VI, Arrazi Hospital, Marrakech, MAR
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, MAR
| | - Oumaima El Kaoua
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Mohammed VI, Arrazi Hospital, Marrakech, MAR
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, MAR
| | - Mariam Chettati
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Mohammed VI, Arrazi Hospital, Marrakech, MAR
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, MAR
| | - Wafaa Fadili
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Mohammed VI, Arrazi Hospital, Marrakech, MAR
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, MAR
| | - Inass Laouad
- Department of Nephrology, Centre Hospitalier Universitaire (CHU) Mohammed VI, Arrazi Hospital, Marrakech, MAR
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, MAR
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Emmi G, Bettiol A, Hatemi G, Prisco D. Behçet's syndrome. Lancet 2024; 403:1093-1108. [PMID: 38402885 DOI: 10.1016/s0140-6736(23)02629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024]
Abstract
Behçet's syndrome is a rare, chronic multisystemic inflammatory disorder also known as the Silk Route disease due to its geographical distribution. Behçet's syndrome is a multifactorial disease and infectious, genetic, epigenetic, and immunological factors contribute to its pathogenesis. Its heterogeneous spectrum of clinical features include mucocutaneous, articular, ocular, vascular, neurological, and gastrointestinal manifestations that can present with a relapsing and remitting course. Differential diagnosis is often hampered by the non-specific clinical presentation and the absence of laboratory biomarkers or pathognomonic histological features. The therapeutic approach is tailored on the basis of patient-specific manifestations and relies on glucocorticoids, colchicine, and traditional and biological immunosuppressants. Despite progress in the knowledge and management of the disease, unmet needs in diagnostics, monitoring, prediction, and treatment personalisation challenge clinical practice, making Behçet's syndrome a complex disorder associated with an increased risk of morbidity.
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, VIC, Australia.
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gülen Hatemi
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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3
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Abstract
Behçet Disease is a relapsing and remitting variable vessel vasculitis characterized by recurrent mucocutaneous ulcers that can involve almost every organ system in the body. Indeed, the presence of recurrent oral or genital ulcers with other auto-inflammatory symptoms should raise suspicion for this elusive disease. It is unique among the vasculitides in that it can affect vessels of small, medium, and large size and tends to involve venous rather than arterial circulation, and its effects on the pulmonary venous circulation are particularly notable for their role in disease mortality. Classically seen in Mediterranean, Middle-Eastern, and eastern Asian countries, and relatively rare in the United States, prevalence has been increasing, prompting an increased need for internists to be aware of Behcet's clinical presentation and treatment. As early recognition and diagnosis of the disease is key to successful treatment and better prognosis, this review provides a brief summary of the current etiological theories, important clinical manifestations, and treatments including newer biologic alternatives.
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Affiliation(s)
- Daniel Pak
- Internal Medicine, St Mary Medical Center, Langhorne, Pennsylvania, USA
| | - Hyon Ju Park
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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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.
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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
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Kul Cinar O, Romano M, Guzel F, Brogan PA, Demirkaya E. Paediatric Behçet's Disease: A Comprehensive Review with an Emphasis on Monogenic Mimics. J Clin Med 2022; 11:1278. [PMID: 35268369 PMCID: PMC8911352 DOI: 10.3390/jcm11051278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Behçet's disease (BD) is a polygenic condition with a complex immunopathogenetic background and challenging diagnostic and therapeutic concepts. Advances in genomic medicine have provided intriguing insights into disease pathogenesis over the last decade, especially into monogenic mimics of BD. Although a rare condition, paediatric BD should be considered an important differential diagnosis, especially in cases with similar phenotypes. Emerging reports of monogenic mimics have indicated the importance of genetic testing, particularly for those with early-onset, atypical features and familial aggregation. Treatment options ought to be evaluated in a multidisciplinary setting, given the complexity and diverse organ involvement. Owing to the rarity of the condition, there is a paucity of paediatric trials; thus, international collaboration is warranted to provide consensus recommendations for the management of children and young people. Herein, we summarise the current knowledge of the clinical presentation, immunopathogenetic associations and disease mechanisms in patients with paediatric BD and BD-related phenotypes, with particular emphasis on recently identified monogenic mimics.
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Affiliation(s)
- Ovgu Kul Cinar
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; (O.K.C.); (P.A.B.)
- Division of Medicine, National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Micol Romano
- Department of Pediatrics, Division of Pediatric Rheumatology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 4V2, Canada
| | - Ferhat Guzel
- Molecular Genetics Laboratories, Department of Research and Development, Ant Biotechnology, Istanbul 34775, Turkey;
| | - Paul A. Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; (O.K.C.); (P.A.B.)
- Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London WC1N 1EH, UK
| | - Erkan Demirkaya
- Department of Pediatrics, Division of Pediatric Rheumatology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada;
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 4V2, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5W9, Canada
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Ogino R, Shimada K, Narai D, Goto M, Sato K, Katsuta Y, Shiigi A, Ueda J, Oyama C, Fujikawa Y, Miyazawa I, Ohara T, Sumitomo K, Sato S, Koinuma N, Kanno A, Furukawa K. Behçet's Disease with Extremely High Levels of Urinary β2-Microglobulin after Non-Steroidal Anti-Inflammatory Drug Treatment. TOHOKU J EXP MED 2021; 254:283-286. [PMID: 34433735 DOI: 10.1620/tjem.254.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behçet's disease is an inflammatory disease which manifests itself as various symptoms, such as uveitis, oral and genital aphthae, erythema nodosa, gastro-intestinal ulcerations and encephalopathy. Among the manifestations, renal dysfunction is reported in some percentage of the patients with this disorder. We experienced a middle-aged male with Behçet's disease who showed an extremely high level of urinary β2-microglulin, which is one of the markers of renal dysfunction, despite normal serum creatinine levels. The patient was on non-steroidal anti-inflammatory drug (NSAID) therapy for 7 weeks, and this could have affected his renal dysfunction. The present report suggests that renal injury should not be underestimated in patients with Behçet's disease, especially in patients using NSAIDs.
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Affiliation(s)
- Ryohei Ogino
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Karin Shimada
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Daiki Narai
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Masanori Goto
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Katsuhiro Sato
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Yoshihisa Katsuta
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Akimasa Shiigi
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Juri Ueda
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Chika Oyama
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Yuko Fujikawa
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Isabelle Miyazawa
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Takahiro Ohara
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Kazuhiro Sumitomo
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Shigeru Sato
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Nobuo Koinuma
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Atsuhiro Kanno
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Katsutoshi Furukawa
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
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Alpsoy E, Bozca BC, Bilgic A. Behçet Disease: An Update for Dermatologists. Am J Clin Dermatol 2021; 22:477-502. [PMID: 34061323 DOI: 10.1007/s40257-021-00609-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Behçet disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology with the clinical features of oral and genital ulcers, cutaneous vasculitic lesions, ocular, articular, vascular, gastrointestinal, neurologic, urogenital and cardiac involvement. BD usually appears around the third or fourth decade of life. Gender distribution is roughly equal. The disease is much more frequent in populations along the ancient 'Silk Road', extending from Eastern Asia to countries in the Middle East and the Mediterranean, compared with Western countries, but has universal distribution. Mucocutaneous manifestations are the clinical hallmarks of BD. The diagnostic criteria widely used in the disease's diagnosis are based on mucocutaneous manifestations because of their high sensitivity and/or specificity. Genetic factors are the key driver of BD pathogenesis, and HLA-B51 antigen is the strongest genetic susceptibility factor. Streptococcus sanguinis (S. sanguinis) or microbiome change can trigger innate immune system-mediated inflammation sustained by adaptive immune responses. Epistatic interaction between HLA-B51 and endoplasmic reticulum aminopeptidase 1 (ERAP1) in antigen-presenting cells disrupt T-cell homeostasis leading to downregulation of Tregs and expansion of Th1 and Th17. Thus, neutrophil activation and intense neutrophil infiltration of the affected organs develop in the early stage of inflammation. BD has a variable clinical course with unpredictable exacerbations and remissions. The disease is associated with a high mortality rate, especially in young male patients, and large-vessel, neurological, gastrointestinal system and cardiac involvement are the most important causes of death. The principal aim of treatment should be to prevent irreversible organ damage, especially during the disease's early, active phase. A better understanding of the disease's pathogenesis has provided important information on its management. New drugs, especially apremilast and anti-TNF-α agents are effective in the management of BD and have the potential to improve patients' quality of life, prognosis and survival.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey.
| | - Burcin Cansu Bozca
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
| | - Asli Bilgic
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
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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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Salmaninejad A, Gowhari A, Hosseini S, Aslani S, Yousefi M, Bahrami T, Ebrahimi M, Nesaei A, Zal M. Genetics and immunodysfunction underlying Behçet's disease and immunomodulant treatment approaches. J Immunotoxicol 2018; 14:137-151. [PMID: 28693405 DOI: 10.1080/1547691x.2017.1346008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a chronic autoimmune condition primarily prevalent in populations along the Mediterranean Sea. The exact etiology of BD has not been fully explained yet, but the disease occurrence is associated with a genetic factor, human leukocyte antigen (HLA)-B51 antigen. Among the various immunodysfunctions that are found in BD, patients are increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin (IL)-10. Elevated levels of inflammatory cytokines like IL-1 and IL-17 in BD have been found associated with aberrant expression of microRNA. Gene polymorphisms in BD patients have been observed in molecules involved in responses to pathogens that can ultimately modulate the host antimicrobial response. Moreover, several single nucleotide polymorphisms (SNPs) have been reported in genes encoding chemokines and adhesion molecules; many of these changes manifest as increases in vascular inflammation and vascular damage. Lastly, genetic and epigenetic changes have been suggested as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to adverse function of these cells. This review presents a comprehensive compilation of the literature with regard to the immunodysfunction underlying BD, as well as of the genetics, newly described clinical specifications and novel treatment strategies using immunomodulants based on the current understanding of BD.
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Affiliation(s)
- Arash Salmaninejad
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran.,b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.,c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Arezoo Gowhari
- d Department of Immunology, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Seyedmojtaba Hosseini
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Saeed Aslani
- c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Meysam Yousefi
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Tayyeb Bahrami
- e Genetics Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Masoume Ebrahimi
- f Department of Biology, Faculty of Sciences , University of Guilan , Rasht , Iran
| | - Abolfazl Nesaei
- g Department of Basic Sciences , Gonabad University of Medical Sciences , Gonabad , Iran
| | - Masoud Zal
- h Department of Medical Genetics , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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10
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Imaging manifestations of Behcet's disease: Key considerations and major features. Eur J Radiol 2017; 98:214-225. [PMID: 29196115 DOI: 10.1016/j.ejrad.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/26/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023]
Abstract
Behcet's disease is an autoimmune disease most commonly seen in the Middle East. Although primarily known with painful oral and genital ulcers, it can lead to vasculitis. Therefore, several associated complications such as thrombotic syndromes, aneurysmal arterial disease may arise. In many cases, it might be difficult to make the diagnosis purely based on clinical grounds; however, imaging plays an important role for both diagnosis and assessment of the disease's complications. We provide a comprehensive review of the most notable imaging findings of Behcet's disease.
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11
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Ko LN, Alloo A, Lin WM, Hoang MP, Kroshinsky D. A 25-Year-Old Male with Orogenital Ulcers, Rash, and Difficulty Swallowing. Dermatopathology (Basel) 2017; 4:7-12. [PMID: 29456995 PMCID: PMC5803722 DOI: 10.1159/000481528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 25-year-old otherwise healthy male presented with new-onset odynophagia, rash, and orogenital ulcers. Despite treatment with antibiotics for presumed bacterial pharyngitis, the patient remained symptomatic, with abnormal vital signs and laboratory values. Upon dermatology consultation and histopathologic correlation, he was diagnosed with Behçet disease. Behçet disease is a rare rheumatologic condition that presents with recurrent oral ulcers and varying degrees of ophthalmic, neurologic, cardiac, and vascular disease. Given its protean nature, the treatment of Behçet disease is tailored to the patient's presentation and severity of organ involvement. Following treatment with colchicine and prednisone, the patient's symptoms improved rapidly.
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Affiliation(s)
- Lauren N Ko
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Allireza Alloo
- Department of Dermatology, Northwell Health, Lake Success, New York, USA
| | - William M Lin
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Mai P Hoang
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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12
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The clinical and pathological characteristics of nephropathies in connective tissue diseases in the Japan Renal Biopsy Registry (J-RBR). Clin Exp Nephrol 2017; 21:1024-1029. [DOI: 10.1007/s10157-017-1398-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 02/21/2017] [Indexed: 01/29/2023]
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13
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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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Abstract
Behçet’s disease (BD) is a multi-system inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis, and erythema nodosum. Behçet’s disease runs a chronic course, with unpredictable exacerbations and remissions whose frequency and severity may diminish with time. Behçet’s disease typically arises in young adults, although childhood-onset BD has also been reported. The disease can affect both genders and has a worldwide distribution, although it is more prevalent in countries of the ancient Silk Route. The cause of BD remains unknown, although an autoimmune reaction triggered by an infectious agent in a genetically predisposed individual has been suggested. The treatment of BD is symptomatic and empirical, but generally specific to the clinical features of each patient. The majority of affected individuals do not have life-threatening disease, although mortality can be associated with vascular-thrombotic and neurological disease.
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Affiliation(s)
- L M Al-Otaibi
- Oral Medicine, Division of Maxillofacial Diagnostic, Medical & Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
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15
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Wu CK, Leu JG, Wei CC, Hsieh SC. Acute thrombosis of a transplanted renal artery after gastric ulcer bleeding in a patient with a long-term well-functioning renal allograft: A case report and literature review. Medicine (Baltimore) 2016; 95:e4301. [PMID: 27472705 PMCID: PMC5265842 DOI: 10.1097/md.0000000000004301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute thrombosis of a transplanted renal artery is a serious vascular complication following renal allograft transplantation, which usually occurs within the first month after transplantation and often results in graft loss. It rarely occurs beyond the first month, except in a rejected kidney or in a kidney with high-grade transplant renal artery stenosis. RESULT A 65-year-old male with a history of type 2 diabetes mellitus, hypertension, pulmonary tuberculosis, and end-stage renal disease was previously treated with hemodialysis (HD). He received a kidney transplant and had a well-functioning graft for 2 years. He presented to our emergency department with gastric ulcer bleeding and received treatment involving an endoscopic submucosal epinephrine injection, a proton pump inhibitor, and blood transfusions. Nine days later, he complained of sudden lower abdominal pain and had acute anuric kidney failure. Renal ultrasonography revealed an absence of blood flow to the allograft kidney. Renal artery angiogram demonstrated complete occlusion of the transplanted renal artery. After thrombectomy and percutaneous transluminal angioplasty (PTA) with stent placement, 60% stenosis of the proximal renal artery with distal perfusion was noted. However, his graft function did not improve, and he received HD again. Histopathology of the transplanted kidney revealed ischemic tubular nephropathy with focal infarction without rejection. CONCLUSION This is the first case of acute thrombosis of the transplanted renal artery following gastric ulcer bleeding in a patient with a long-term well-functioning graft kidney.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
- Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
- Schoolof Medicine, Fu-Jen Catholic University, New Taipei City
| | - Cheng-Chun Wei
- Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shih-Chung Hsieh
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
- Correspondence: Shih-Chung Hsieh, Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, 95, Wen Chang Rd., Shih Lin District, Taipei 11101, Taiwan (e-mail: )
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16
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Ozel D, Ozel BD, Ozkan F, Kutlu R. Evalution of Renal Involvement in Patients with Behçet Disease: Need to be Aware About Potential Hypertension in Long Term Follow Up? Pol J Radiol 2016; 81:5-9. [PMID: 26937259 PMCID: PMC4750757 DOI: 10.12659/pjr.895446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKROUND The aim of this study was to evaluate frequency and severity of kidney involvement with some clinical, ultrasonography and color Doppler measurements in patients with Behçet disease. MATERIAL/METHODS This study was including 32 patients with Behçet disease and 32 healthy sex and age-matched control subjects. Patients were divided into two groups as period of disease 0-6 years and 7 years and above to evaluate effect of duration of disease. We evaluated some biochemical tests in both blood and urine related to renal functions, blood pressure values. Gray scale and color Doppler findings were noted. RESULTS Renal artery volume flow in patients with a duration of 7 years or above was significantly decreased compared to control group (p<0.05). However, gray scale ultrasound and color Doppler measurements reveal there was not statistically significant change compared to control group. There was no biochemical abnormalities in any patient. Four patients had elevated blood pressure but mean blood pressure values were not statistically different compared to volunteers. CONCLUSIONS Renal involvement ratios varies in different studies but not common. End stage renal failure can be seen very rare. Furthermore, vasculitic changes can lead renal artery narrowness and can result to decrease in renal blood flow. It has a potential to activate renin angiotensin aldosterone cascade to elevate blood pressure. We must be aware about blood pressure of patients with Behçet disease, especially with long term follow up.
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Affiliation(s)
- Deniz Ozel
- Radiology Clinic, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Betul Duran Ozel
- Radiology Clinic, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Fuat Ozkan
- Radiology Clinic, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Ramazan Kutlu
- Department of Radiology, İnönü University, Faculty of Medicine, Malatya, Turkey
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17
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Abstract
Behçet's disease (BD) is a multisystem disorder of unknown etiology. Renal involvement in Behçet's disease is not frequent. Pauciimmune necrotizing and crescentic glomerulonephritis is associated with antineutrophil cytoplasmic antibodies (ANCA) which are believed to activate neutrophils and cause vasculitis, especially if there is a concurrent synergistic inflammatory process. In this case report, we describe a patient diagnosed with BD who also developed pauciimmune necrotizing and crescentic glomerulonephritis. We also compared this case with similar previous cases reported in the literature. The aim of this study is to add information regarding ANCA, pauciimmune glomerulonephritis and Behçet's disease.
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Affiliation(s)
- Duriye Deren Oygar
- Nephrology Department, Nicosia General Hospital, Burhan Nalbantoglu Hospital, Cyprus
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18
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Zheng W, Li G, Zhou M, Chen L, Tian X, Zhang F. Renal involvement in Chinese patients with Behcet's disease: a report of 16 cases. Int J Rheum Dis 2015; 18:892-7. [PMID: 25557053 DOI: 10.1111/1756-185x.12529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the clinical and pathological characteristics of renal involvement in Behcet's disease (BD). METHODS A retrospective analysis was carried out in BD patients complicated with renal damage who were hospitalized in Peking Union Medical College Hospital from June 1998 to July 2012. RESULTS There were 16 BD patients with renal involvement, accounted for 2.6% of all the 618 hospitalized BD patients. The presentation of renal disease was chronic glomerulonephritis in six patients (including one with nephritic syndrome), renal tubular acidosis in one patient, renal artery stenosis in eight patients and renal vein thrombosis in one patient. Renal biopsy was performed in five patients, three of whom revealed to have minor glomerular lesions, mild mesangial proliferative glomerulonephritis and chronic tubular-interstitial nephropathy, respectively. The other two patients underwent a second biopsy, the one with minor glomerular lesion in the first biopsy was transformed into grade III immunoglobulin A (IgA) nephropathy on Lee's glomerular grading system 6 years later, and the other one who had IgA nephropathy of grade II in the first biopsy was progressed to grade IV 2 years later. Among the nine patients with renal vascular involvement, two underwent surgery, and several received anticoagulant therapy. During the follow-up of 13 patients, the urine protein quantifications were reduced, and renal function remained relatively stable. CONCLUSIONS Renal damage is relatively uncommon in BD patients. There are various clinical presentations of renal involvement in BD. Routine screening with urinalysis, serum creatinine and imaging studies should be carried out for the early diagnosis of renal involvement in BD.
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Affiliation(s)
- Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Guohua Li
- Department of Nephrology, Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot, China
| | - Mengyu Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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19
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Salzberg DJ, Weir MR. The kidney and rheumatic disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Park SH, Kim JH, Lee JY, Shin SK, Hong YK, Kie JH, Kang DY, Lee CH. A Case of Thymic Carcinoma with Behcet's Disease Combined with Immunoglobulin A Nephropathy. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.2.118] [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)
- Se Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yoen Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sug Kyun Shin
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Kook Hong
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jeong Hae Kie
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Du Yong Kang
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chan Hee Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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21
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Mazzoccoli G, Matarangolo A, Rubino R, Inglese M, De Cata A. Behçet syndrome: from pathogenesis to novel therapies. Clin Exp Med 2014; 16:1-12. [PMID: 25447032 DOI: 10.1007/s10238-014-0328-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/22/2014] [Indexed: 12/11/2022]
Abstract
Behçet syndrome is a chronic disease hallmarked by inflammation of the blood vessels that is related to an autoimmune reaction caused by inherited susceptibility due to specific genes and environmental factors, probably components of infectious microorganisms, which turn on or get going the disease in genetically susceptible subjects. The more common clinical expression of the disease is represented by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis, sometimes associated with inflammatory arthritis, phlebitis, iritis, as well as inflammation of the digestive tract, brain, and spinal cord. The treatment strategies used to manage the manifestations of Behçet syndrome have gradually progressed, and a number of new therapeutic resources have been implemented in recent years, allowing better control of pathogenic mechanisms, reducing symptoms and suffering, and ameliorating patient's outcome.
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Affiliation(s)
- Gianluigi Mazzoccoli
- Division of Internal Medicine and Chronobiology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy.
| | - Angela Matarangolo
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Rosa Rubino
- Division of Internal Medicine and Chronobiology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Michele Inglese
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Angelo De Cata
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy.
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22
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Roscoe C, Kinney R, Gilles R, Blue S. Behçet's disease diagnosed after acute HIV infection: viral replication activating underlying autoimmunity? Int J STD AIDS 2014; 26:432-5. [PMID: 24912539 DOI: 10.1177/0956462414539667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/14/2014] [Indexed: 01/19/2023]
Abstract
Behçet's disease is an autoimmune systemic vasculitis that can occur after exposure to infectious agents. Behçet's disease also has been associated with HIV infection, including de novo development of this condition during chronic HIV infection and resolution of Behçet's disease symptoms following initiation of antiretroviral therapy. We describe a patient who presented with systemic vasculitis with skin and mucous membrane ulcerations in the setting of acute HIV infection, who was eventually diagnosed with Behçet's disease, demonstrating a possible link between acute HIV infection, immune activation and development of autoimmunity.
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Affiliation(s)
- Clay Roscoe
- HIV Services, Family Medicine Residency of Idaho, Boise, ID, USA
| | - Rebecca Kinney
- Partnership Health Center, Family Medicine Residency of Western Montana, Montana, MT, USA
| | - Ryan Gilles
- Kootenai Health Family Medicine Couer d'Alene Residency, Couer d'Alene, ID, USA
| | - Sky Blue
- HIV Services, Family Medicine Residency of Idaho, Boise, ID, USA
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23
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Kitai Y, Murakami K, Yoshifuji H, Yukawa N, Kawabata D, Ohmura K, Fujii T, Mimori T. A case of Behçet’s disease developing after poststreptococcal acute glomerulonephritis. Mod Rheumatol 2013. [DOI: 10.3109/s10165-012-0736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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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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25
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Cho SB, Kim J, Kang SW, Yoo TH, Zheng Z, Cho S, Lee HS, Bang D. Renal manifestations in 2007 Korean patients with Behçet's disease. Yonsei Med J 2013; 54:189-96. [PMID: 23225818 PMCID: PMC3521277 DOI: 10.3349/ymj.2013.54.1.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Behçet's disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels. MATERIALS AND METHODS A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD. RESULTS Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies. CONCLUSION We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.
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Affiliation(s)
- Sung Bin Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jihyun Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Division of Nephrology, Department of Internal Medicine, BK21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Division of Nephrology, Department of Internal Medicine, BK21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Zhenlong Zheng
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Dermatology, Yanbian University Hospital, Yanji, China
| | - Suhyun Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Dongsik Bang
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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26
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Renal amyloidosis in Behçet's disease: clinicopathologic features of 8 cases. Int Urol Nephrol 2012; 45:785-94. [PMID: 22961375 DOI: 10.1007/s11255-012-0268-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Behçet's disease (BD) is a rare inflammatory disorder with variable articular and systemic manifestations. Amyloidosis is an uncommon complication of BD. The aim of this study is to present clinicopathological characteristics and outcome of 8 patients with renal amyloidosis secondary to BD. METHODS A total of 220 cases of secondary-type renal amyloidosis diagnosed over 26-year period (1981-2007) in a single institution via needle biopsy were reviewed retrospectively, and accompanying BD was found in ten of them. Clinical and follow-up information of the patients was gathered from hospital records and computer-based data system. Two cases were excluded from the study due to another concomitant preamyloidotic condition. Biopsy slides of remaining 8 cases were culled from the archives and re-examined. Extent and pattern of renal amyloid deposition were explored. Amyloid typing was accomplished via immunohistochemistry. Factors acting on outcome and renal survival were explored. RESULTS Patients were all male (age range 27-56). Duration of BD before diagnosis of amyloidosis varied from 24 to 192 months, and mean follow-up period was 89 months. Nephrotic syndrome was the most common presentation. Immunohistochemical typing revealed AA-amyloid in all cases. Two cases showed glomerular-dominant, one case vascular-dominant amyloid deposition, and rest were codominant glomerular and vascular, except one that was indeterminate. Patients were treated with steroids and/or different immunosuppressives, three progressed to end-stage kidney failure. CONCLUSION Behçet's disease is one of the rare diseases that lead to AA amyloidosis. Morphology of renal amyloidosis due to BD has diversities in terms of differential amyloid deposition in renal compartments. Patients follow variable clinical courses accordingly.
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27
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A case of Behçet’s disease developing after poststreptococcal acute glomerulonephritis. Mod Rheumatol 2012; 23:1221-5. [DOI: 10.1007/s10165-012-0736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
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28
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Mohammed RHA, Nasef A, Kewan HH, Al Shaar M. Vascular neurobehcet disease: correlation with current disease activity forum and systemic vascular involvement. Clin Rheumatol 2012; 31:1033-40. [PMID: 22415466 DOI: 10.1007/s10067-012-1953-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 12/18/2011] [Accepted: 01/28/2012] [Indexed: 02/07/2023]
Abstract
Behcet's syndrome (BS) is a chronic relapsing vascular inflammatory disease of unknown etiology with high morbidity and mortality. This research aims to study the clinical patterns of CNS disease in a group of patients with BS as well as the frequency and type of the associated radiographic findings suggestive of structural cerebral vascular disease. The findings were studied in relation to disease activity and features of systemic vascular involvement. Forty patients fulfilling the diagnostic criteria of the International Study Group for Behcet's Disease, mean age of 33.56 ± 9.7 years, were enrolled. Patients were subjected to magnetic resonance imaging with conjugate survey of cerebral blood vessels' flow pattern abnormalities by transcranial Doppler study. Thirty healthy controls were included. Behcet's Disease Current Activity Form Score was used. Neuro-Behcet's syndrome (NBS) was diagnosed in 37.5% with headache being the most common (86.6% of cases), pyramidal affection (signs of upper motor neuron lesions/hemiplegia) was reported in 33.3%, attacks of disturbed conscious level in 26.6%, and cranial nerve affection in 6.5%. Of the patients, 66.6% with clinical features of NBS had statistically significant radiographic evidences of cerebrovascular disease (p = 0.01). Patients with NBS had significantly higher disease activity index score (r = 0.69, p = 0.0001). Radiographic findings and flow abnormalities were significantly less in patients on immune suppressants and antiplatelet drugs (p = 0.003, 0.04). BS patients with clinical neurologic disease were found to have radiographic findings suggestive of cerebral vascular disease with high disease activity index score. Drugs like immunosuppressants and oral antiplatelets might retard cerebral vascular disease progression and flow abnormalities, respectively.
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Affiliation(s)
- Reem H A Mohammed
- Department of Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt.
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29
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Abstract
UNLABELLED DEFINITION OF THE DISEASE: Behçet disease (BD) is a chronic, relapsing, multisystemic disorder characterized by mucocutaneous, ocular, vascular and central nervous system manifestations. EPIDEMIOLOGY BD seems to cluster along the ancient Silk Road, which extends from eastern Asia to the Mediterranean basin. European cases are often described, not exclusively in the migrant population. CLINICAL DESCRIPTION The clinical spectrum includes oral and genital ulcerations, uveitis, vascular, neurological, articular, renal and gastrointestinal manifestations. ETIOLOGY The etiopathogenesis of the disease remains unknown, although genetic predisposition, environmental factors and immunological abnormalities have been implicated. DIAGNOSTIC METHODS Diagnosis is only based on clinical criteria. DIFFERRENTIAL DIAGNOSIS: It depends on the clinical presentation of BD, but sarcoidosis, multiple sclerosis, Crohn's disease, Takayasu's arteritis, polychondritis or antiphospholipid syndrome need to be considered. MANAGEMENT Treatment is symptomatic using steroids and immunomodulatory therapy. It is efficient depending on the rapidity of initiation, the compliance, and the duration of therapy. PROGNOSIS The prognosis is severe due to the ocular, neurological and arterial involvement.
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Affiliation(s)
- David Saadoun
- Service de Médecine Interne 2, Centre de Référence Maladies Autoimmunes rares, CHU Pitié-Salpêtrière, 83 Bd de l'Hôpital, 75013, Paris, France
| | - Bertrand Wechsler
- Service de Médecine Interne 2, Centre de Référence Maladies Autoimmunes rares, CHU Pitié-Salpêtrière, 83 Bd de l'Hôpital, 75013, Paris, France
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30
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Kim HJ, Kang SW, Park SJ, Kim TH, Kang MS, Kim YH. Fibrillary glomerulonephritis associated with Behçet's syndrome. Ren Fail 2012; 34:637-9. [PMID: 22417126 DOI: 10.3109/0886022x.2012.664507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fibrillary glomerulonephritis (FGN) is a rare cause of progressive renal dysfunction resulting in fibrillary deposits in the mesangium and/or glomerular basement membrane (GBM). Some case reports have shown FGN in patients with rheumatoid arthritis and other autoimmune diseases. This is the first case report of FGN in a patient with Behçet's syndrome. The most common renal histological finding in Behçet's syndrome is secondary amyloidosis. A 46-year-old woman with a 4-year history of Behçet's syndrome was referred to the nephrology clinic with foamy urine with non-selective proteinuria (urine protein-to-creatinine ratio was 1400 mg protein/g creatinine) and microscopic hematuria. Serum and urine protein electrophoresis showed no evidence of monoclonal gammopathy. A renal biopsy was performed. Light microscopy showed mesangial widening and nodular expansion with hyaline deposits. Immunofluorescence microscopy revealed immunoglobulin M deposits in the mesangium. Congo red staining was negative. Electron microscopy showed fibrillary deposits on the GBM. Pathological findings were consistent with FGN. She had been taking 50 mg azathioprine and 3000 mg mesalazine per day for 4 years due to Behçet's syndrome, so we did not add any other immunosuppressive agents or corticosteroids. Treatment of this glomerulopathy is not promising. It has been noted that none of the various approaches, including corticosteroid, plasmapheresis, and cytotoxic therapy, improves prognosis.
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Affiliation(s)
- Hyun Ju Kim
- Department of Nephrology, College of Medicine, Pusan Paik Hospital, Inje University, Busan, Republic of Korea
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31
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García-Palenzuela R, Graña Gil J, Varela Arias M, Tovar Bobo M. Actualización de la enfermedad de Behçet. A propósito de 2 casos en atención primaria. Semergen 2012. [DOI: 10.1016/j.semerg.2011.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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32
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Abstract
Renal amyloidosis is a detrimental disease caused by the deposition of amyloid fibrils. A child with renal amyloidosis may present with proteinuria or nephrotic syndrome. Chronic renal failure may follow. Amyloid fibrils may deposit in other organs as well. The diagnosis is through the typical appearance on histopathology. Although chronic infections and chronic inflammatory diseases used to be the causes of secondary amyloidosis in children, the most frequent cause is now autoinflammatory diseases. Among this group of diseases, the most frequent one throughout the world is familial Mediterranean fever (FMF). FMF is typically characterized by attacks of clinical inflammation in the form of fever and serositis and high acute-phase reactants. Persisting inflammation in inadequately treated disease is associated with the development of secondary amyloidosis. The main treatment is colchicine. A number of other monogenic autoinflammatory diseases have also been identified. Among them cryopyrin-associated periodic syndrome (CAPS) is outstanding with its clinical features and the predilection to develop secondary amyloidosis in untreated cases. The treatment of secondary amyloidosis mainly depends on the treatment of the disease. However, a number of new treatments for amyloid per se are in the pipeline.
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Affiliation(s)
- Yelda Bilginer
- Hacettepe University Faculty of Medicine, Pediatric Nephrology and Rheumatology Unit, Ankara, Turkey
| | - Tekin Akpolat
- Department of Nephrology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Seza Ozen
- Hacettepe University Faculty of Medicine, Pediatric Nephrology and Rheumatology Unit, Ankara, Turkey
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The kidney and rheumatic disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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The "other" vasculitis syndromes and kidney involvement. Pediatr Nephrol 2010; 25:1633-9. [PMID: 19898878 PMCID: PMC2908464 DOI: 10.1007/s00467-009-1327-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 11/16/2022]
Abstract
There are a number of vasculitides that are not confined to a specific vessel size, do not have characteristic features, and/or are not secondary to another disease. Most of these vasculitides are rare in childhood. Behçet disease is representative of this group as it involves vessels of any size on both the arterial and venous side. In addition to renal vascular involvement, Behçet disease may involve the kidney through glomerulonephritis, secondary amyloidosis and, rarely, tubulointerstital involvement. Vasculitis secondary to infections, malignancy, and drugs are not common among children. However, vasculitis may be associated with a number of rheumatic diseases in childhood and the auto-inflammatory syndromes (periodic fever syndromes). Auto-inflammatory syndromes are diseases characterized by periodic attacks of clinical and laboratory inflammation. Studies carried out during the past decade have provided valuable information on the mechanism of inflammation and innate immunity in general. This group of vasculitides is associated with secondary amyloidosis of the kidney if not treated. Hypocomplementemic urticarial vasculitis is an interesting vasculitic disease with frequent kidney involvement. Here, we introduce the reader to the wide scope of these diseases; although rare, such diseases represent a challenge to the nephrologist.
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A severe renal bleeding as a complication of coumarin therapy in Behçet's disease. Blood Coagul Fibrinolysis 2010; 21:487-90. [DOI: 10.1097/mbc.0b013e328338cded] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alli N, Gur G, Yalcin B, Hayran M. Patient characteristics in Behçet disease: a retrospective analysis of 213 Turkish patients during 2001-4. Am J Clin Dermatol 2009; 10:411-8. [PMID: 19824742 DOI: 10.2165/11310880-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behçet disease (BD) is a chronic, inflammatory, multisystemic vasculitic disorder with a wide spectrum of clinical presentations. The highest prevalence is seen in Turkey. Specific diagnostic tools are yet to be discovered; thus, the diagnosis relies on physicians being acquainted with the symptoms and signs of the disease. OBJECTIVE To investigate the epidemiologic characteristics of BD and to emphasize the typical clinical and laboratory characteristics. METHODS This was a retrospective analysis of all the BD patients attending the Ankara Numune Education and Research Hospital throughout the years 2001-4. Diagnosis of BD was made according to the International Study Group criteria. A total of 213 patients were evaluated with respect to family history, clinical features, pathergy test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antistreptolysin O, and ferritin levels. When assessing disease activity, the active clinical manifestations on the day of the examination were taken into account. Correlations were analyzed between sex and age distribution, age of onset, disease duration, and family history; and between family history and age of onset, pathergy, clinical manifestations, and laboratory parameters. Correlations were also evaluated between pathergy positivity and clinical manifestations, and laboratory parameters. Correlations between activity scores and age of onset, duration, sex, family history, and laboratory data were also analyzed. RESULTS The female : male ratio was 1.04, and the mean age of onset was 27 years. Family history did not affect age of onset or disease severity. Men presented with more active disease, and there was a weak but positive correlation between disease activity and CRP. No correlation was observed between duration and age of disease onset. The most common clinical presentations were oral aphthous lesions, genital ulcers, and skin lesions. Men more commonly presented with papulopustular lesions, pathergy positivity, and vascular, eye, and renal involvement, and women presented with arthritis/arthralgia more commonly than men. Vascular lesions, ESR, and CRP showed significant relationships with pathergy reaction. Eye involvement was not affected by age of onset. CONCLUSIONS We believe our results indicate that the pathogenesis of BD is multifactorial. Hormonal factors seem to be of some influence, while genetic background and environmental factors seem to be the major contributors. Infections seem to be among the triggering environmental factors. Predisposing genes may affect the influence of environmental factors. Prevalence studies should be carried out periodically in those countries with a high prevalence of BD to keep up with the changing dynamics of the disease, which may also shed light on the as-yet unknown pathogenesis of BD.
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Affiliation(s)
- Nuran Alli
- Department of Dermatology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Kavala M, Menteş F, Kocaturk E, Ergin H, Zindanci I, Can B, Turkoglu Z, Südogan S. Microalbuminuria as an early marker of renal involvement in Behcet's disease: it is associated with neurological involvement and duration of the disease. J Eur Acad Dermatol Venereol 2009; 24:840-3. [PMID: 19925600 DOI: 10.1111/j.1468-3083.2009.03488.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite its nature as a systemic vasculitis, renal involvement is known to occur infrequently in Behçet's Disease (BD). OBJECTIVES Our aim was to investigate proteinuria, microhematuria and microalbuminuria in 24-h urine and evaluate subclinical or symptomatic renal involvement in BD patients. METHODS Two hundred and eleven patients who fulfilled the International Behçet's Disease criteria were included in the study. After urine analysis, five of 12 patients who were found to have proteinuria underwent renal biopsy, while 199 patients without proteinuria were investigated for microalbuminuria (MA). RESULTS A total of 34 (16.1%) patients were found to have renal involvement including 22 (11.1%) with MA and 12 with proteinuria (5.6%). Renal biopsies resulted as focal glomerulosclerosis in three, membranous glomerulosclerosis in one and secondary amyloidosis in two patients. Neurological involvement was found to be significantly more prevalent in patients with MA (P < 0.01). Neurological involvement and duration of disease (> or = 10 years) was found to increase the risk for MA by 21.75-fold and 5.03-fold, respectively. Though age over 40 years, thrombophlebitis, HLA B51 haplotype and ophthalmological involvement were not found to be significantly associated with MA; these parameters increased the risk for MA. CONCLUSIONS Renal involvement may be more prevalent in BD than it has been recognized; it usually presents with asymptomatic microhematuria, proteinuria and/or microalbuminuria; therefore clinicians must check 24-h urine for the presence of proteinuria, microhematuria and microalbuminuria; especially in patients who are aged over 40 years, have a longer duration of the disease and multisystem involvement.
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Affiliation(s)
- M Kavala
- Department of Dermatology, Goztepe Training and Research Hospital, Istanbul, Turkey
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Sahin I, Noyan T, Karaman E, Yalçinkaya AS, Metin A, Akpolat T. Mild Renal Injury in Behçet's Disease. Ren Fail 2009; 26:55-7. [PMID: 15083923 DOI: 10.1081/jdi-120028549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
AIM The aim of this study is to investigate the frequency of microalbuminuria and abnormal urinary beta2-microglobulin excretion in patients with Behçet's disease (BD). MATERIALS AND METHODS Twenty-eight patients and 27 healthy controls were included in this study. Urine albumin/creatinine and beta2-microglobulin/creatinine ratios were calculated. RESULTS The frequency of microalbuminuria and abnormal urinary beta2-microglobulin excretion was higher among patients with BD than in control group, but this was not statistically significant (p > 0.05). CONCLUSION Microalbuminuria and abnormal beta2-microglobulin excretion are markers of renal injury, which have not been investigated in BD previously. Renal injury in BD is more frequent than has been recognized and it is most often in mild nature.
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Affiliation(s)
- Idris Sahin
- Department of Internal Medicine and Nephrology, Yüzüncü Yil University Medical School Training Hospital, Van, Turkey.
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Keogan MT. Clinical Immunology Review Series: an approach to the patient with recurrent orogenital ulceration, including Behçet's syndrome. Clin Exp Immunol 2009; 156:1-11. [PMID: 19210521 PMCID: PMC2673735 DOI: 10.1111/j.1365-2249.2008.03857.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2008] [Indexed: 01/30/2023] Open
Abstract
Patients presenting with recurrent orogenital ulcers may have complex aphthosis, Behçet's disease, secondary complex aphthosis (e.g. Reiter's syndrome, Crohn's disease, cyclical neutropenia) or non-aphthous disease (including bullous disorders, erythema multiforme, erosive lichen planus). Behçet's syndrome is a multi-system vasculitis of unknown aetiology for which there is no diagnostic test. Diagnosis is based on agreed clinical criteria that require recurrent oral ulcers and two of the following: recurrent genital ulcers, ocular inflammation, defined skin lesions and pathergy. The condition can present with a variety of symptoms, hence a high index of suspicion is necessary. The most common presentation is with recurrent mouth ulcers, often with genital ulcers; however, it may take some years before diagnostic criteria are met. All patients with idiopathic orogenital ulcers should be kept under review, with periodic focused assessment to detect evolution into Behçet's disease. There is often a delay of several years between patients fulfilling diagnostic criteria and a diagnosis being made, which may contribute to the morbidity of this condition. Despite considerable research effort, the aetiology and pathogenesis of this condition remains enigmatic.
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Affiliation(s)
- M T Keogan
- Department of Immunology, Beaumont Hospital, Dublin, Ireland.
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Akpolat T, Dilek M, Aksu K, Keser G, Toprak Ö, Ci̇ri̇t M, Oğuz Y, Taşkapan H, Adibelli̇ Z, Akar H, Tokgöz B, Arici M, Çeli̇ker H, Di̇ri̇ B, Akpolat I. Renal Behçet's Disease: An Update. Semin Arthritis Rheum 2008; 38:241-8. [PMID: 18221990 DOI: 10.1016/j.semarthrit.2007.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 11/10/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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Hashimoto T, Toya Y, Kihara M, Yabana M, Inayama Y, Tanaka KI, Iwatsubo K, Yanagi M, Oshikawa J, Kokuho T, Kuji T, Yoshida SI, Tamura K, Umemura S. Behçet's disease complicated by IgA nephropathy with nephrotic syndrome. Clin Exp Nephrol 2008; 12:224-7. [PMID: 18224274 DOI: 10.1007/s10157-008-0029-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 12/09/2007] [Indexed: 01/05/2023]
Abstract
A 65-year-old woman with a 48-year history of Behçet's disease associated with nephrotic syndrome is described. Immunofluorescence study revealed IgA nephropathy. Following treatment with an angiotensin II type-I receptor-blocker, an anti-platelet drug, and an HMG-CoA reductase inhibitor, accompanied by dietary restrictions of protein and sodium, proteinuria was markedly decreased. This report describes our experience with a rare entity of Behçet's disease complicated by nephrotic syndrome due to IgA nephropathy. Routine urine examination and renal biopsy are needed for the detection and diagnosis of renal problems with Behçet's disease.
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Affiliation(s)
- Tatsuo Hashimoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama 236-0004, Japan.
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An Unusual Vascular Involvement in a Patient With Behcet’s Disease: Renal Artery Stenosis. Am J Med Sci 2007; 334:396-8. [DOI: 10.1097/maj.0b013e318068d7c3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Borhani Haghighi A, Sharifzad HR, Matin S, Rezaee S. The pathological presentations of neuro-Behçet disease: a case report and review of the literature. Neurologist 2007; 13:209-14. [PMID: 17622913 DOI: 10.1097/01.nrl.0000263698.26284.cf] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report the neuropathologic features of a patient with neuro-Behçet disease and to review the literature. METHODS Herein, we describe a 35-year-old male who fulfills the International Study Group criteria for Behçet disease. RESULTS The patient developed headache and hemiparesis in a subacute course. His neurologic examination revealed an altered level of consciousness and unilateral corticospinal signs. The brain magnetic resonance imaging (MRI) showed areas with increased signal intensity in the basal ganglia and cerebral peduncles in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. Cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis but normal protein and glucose levels. After his death, the patient's autopsy revealed a perivascular infiltration of mononuclear inflammatory cells, most prominently in basal ganglia, midbrain, and thalamic regions and the subarachnoid space, consistent with presentations of neuro-Behçet disease. CONCLUSION Pathologic findings of central nervous system involvement in Behçet disease mainly include perivascular infiltration with lymphocytes, neutrophils and rarely, eosinophils, with or without signs of necrosis. The most common sites of brain involvement include the brainstem and basal ganglia. Nonetheless, other areas can also be involved.
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Asghar M, Ahmed K, Shah SS, Siddique MK, Dasgupta P, Khan MS. Renal Vein Thrombosis. Eur J Vasc Endovasc Surg 2007; 34:217-23. [PMID: 17543556 DOI: 10.1016/j.ejvs.2007.02.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 02/26/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein thrombosis. MATERIALS AND METHODS We searched the published literature from Medline & Pubmed using keywords renal vein thrombosis, anti-phospholipid syndrome and nephrotic syndrome. Data was extracted from individual case reports, case series, articles on pathology, diagnostic tests, treatment modalities, and previous reviews. Case reports which did not add any new information were excluded. RESULTS We selected 60 references based on the above criteria. Renal vein thrombosis is relatively rare. CT angiography is considered the investigation of choice. Alternatives include MR angiography or renal venography in highly selected patients. As the condition is relatively uncommon, consensus on the best form of therapy for this condition has been slow to evolve. The trend in management has shifted to non-surgical therapies particularly systemic anticoagulation except in highly selected group of patients.
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Affiliation(s)
- M Asghar
- Department of Urology, Guy's Hospital, London SE1 9RT, UK
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Uzun O, Erkan L, Akpolat I, Findik S, Atici AG, Akpolat T. Pulmonary involvement in Behçet's disease. ACTA ACUST UNITED AC 2007; 75:310-21. [PMID: 17446699 DOI: 10.1159/000101954] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 01/24/2007] [Indexed: 01/27/2023]
Abstract
BACKGROUND Behçet's disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate poor prognosis and high mortality. OBJECTIVES The aims of this study were to report on patients with pulmonary involvement and to discuss pulmonary artery thrombus and small-sized vasculitis associated with BD, with respect to previously published cases. METHODS Fifteen patients with BD and pulmonary involvement were included in this study. Massive hemoptysis was observed in all patients having pulmonary artery aneurysm (PAA). RESULTS Eleven patients had macroscopic pulmonary vascular disease (2 PAA, 3 PAA and thrombi and 6 only thrombi) and 3 patients had microscopic pulmonary vascular disease. The remaining patient had pulmonary cryptococcosis. CONCLUSIONS Data regarding treatment and outcomes of patients having BD-related pulmonary emboli/infarct and small-sized vasculitis are limited. Pulmonary vasculitis affects different levels of the pulmonary artery in BD and should be classified as macroscopic and microscopic vascular disease. 'Pulmonary artery thrombosis' should be used instead of 'pulmonary emboli'. Spiral CT angiography is the best radiological tool for evaluation of pulmonary problems in BD. Treatment of vasculitis should be based on the type of vascular disease and may vary among different types of vascular disease. Anticoagulation can be used in patients with microscopic vascular disease and nonaneurysmal macroscopic vascular disease. More studies are needed to clarify this issue.
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Affiliation(s)
- Oğuz Uzun
- Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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Utku U, Dilek M, Akpolat I, Bedir A, Akpolat T. SAA1 alpha/alpha alleles in Behçet's disease related amyloidosis. Clin Rheumatol 2006; 26:927-9. [PMID: 17039260 DOI: 10.1007/s10067-006-0435-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 08/31/2006] [Indexed: 10/24/2022]
Abstract
Behçet's disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous alpha/alpha is present in 78% of patients with BD and amyloidosis. The SAA1 alpha/alpha genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of alpha/alpha genotype in BD related amyloidosis. To our knowledge, the relationship between alpha/alpha genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 alpha/alpha genotype is a risk factor for amyloidosis in BD.
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Affiliation(s)
- Umut Utku
- Ondokuz Mayis Universitesi, Tip Fakültesi, Nefroloji Bilim Dali, Samsun, 55139, Turkey.
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Oğuz AK, Ozçakar L, Kaymak B. Rare abdominal findings in Behçet’s disease. Clin Rheumatol 2006; 25:889-90. [PMID: 16552461 DOI: 10.1007/s10067-006-0284-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 03/06/2006] [Accepted: 03/06/2006] [Indexed: 11/27/2022]
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Samarkos M, Loizou S, Vaiopoulos G, Davies KA. The Clinical Spectrum of Primary Renal Vasculitis. Semin Arthritis Rheum 2005; 35:95-111. [PMID: 16194695 DOI: 10.1016/j.semarthrit.2005.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The vasculitides are potentially severe and often difficult to diagnose syndromes. Many forms of vasculitis may involve the kidneys. This review will focus on the clinical and histopathological aspects of renal involvement in the systemic vasculitides. METHODS We searched the MEDLINE database using as key terms the MeSH terms and textwords for different forms of vasculitis and for renal involvement, creating a database of more than 2200 relevant references. RESULTS The frequency of renal involvement in vasculitis varies among different syndromes. It is more frequent in Wegener's granulomatosis and microscopic polyarteritis, while it is uncommon to rare in other forms of vasculitis such as Behçet's disease and relapsing polychondritis. The vessels affected include the renal artery in Takayasu arteritis, medium-size renal parenchymal artery in classic polyarteritis nodosa, and glomerular involvement in Wegener's granulomatosis and microscopic polyarteritis. The clinical expression of renal vasculitis depends on the size of the affected vessels and includes renovascular hypertension, isolated nonnephrotic proteinuria, interstitial nephritis, and glomerulonephritis, which can be rapidly progressive. Diagnosis is established by a combination of history, clinical manifestations, laboratory findings (eg, urine sediment, urine protein, antineutrophil cytoplasmic antibodies), imaging techniques (renal angiography, especially when there is a suspicion of medium-to-large vessel disease, and chest radiograph), and finally, renal biopsy. Prognosis varies from unfavorable in the rapidly progressive glomerulonephritis of microscopic polyarteritis, which can lead to renal failure, chronic dialysis, and renal transplantation, to benign, as in the case of Henoch Schonlein purpura, in which the majority of patients recover. CONCLUSIONS The manifestations and prognosis of renal vasculitis range widely. Renal involvement greatly influences prognosis and dictates the need for early and prompt immunosuppressive therapy. Thus, the clinician should be alert for the timely diagnosis and treatment of renal vasculitis.
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Affiliation(s)
- Michael Samarkos
- 5th Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
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