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Gobeka HH, Balcı A, Doğan M, Ay İE, Yörükoğlu Kayabaş S, Büyükokudan U. Optical coherence tomography angiography characteristics of retinochoroidal and optic nerve head microcirculation in cryptogenic organizing pneumonia. Photodiagnosis Photodyn Ther 2023; 43:103720. [PMID: 37487811 DOI: 10.1016/j.pdpdt.2023.103720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND To assess retinochoroidal and optic nerve head microcirculation alterations in cryptogenic organizing pneumonia. METHODS Thirty cryptogenic organizing pneumonia patients in the resolution phase (group 1, 30 right eyes) and 33 healthy subjects (group 2, 33 right eyes) were compared. Patients had 40 mg/day corticosteroids for 8-10 days, and a pulmonary function test, which revealed only minimally restrictive ventilation features. After gathering demographic data, a comprehensive ophthalmological exam and optical coherence tomography angiography were performed three months following maximum disease resolution with corticosteroid therapy RESULTS: Groups 1 and 2 had mean ages of 54.37±14.87 and 49.61±12.36 years, respectively (P = 0.171). Despite the lack of statistical significance, superficial and deep capillary plexus vessel densities in all macular regions were lower in group 1, as were foveal avascular zone parameters (P>0.05). However, the outer retinal and choriocapillaris flows increased significantly in group 1, especially in select areas (P<0.001, for both). There were no significant differences in whole image (P = 0.346), inside disk (P = 0.438), or peripapillary (P = 0.185) optic nerve head vessel densities between the two groups; however, nasal (P<0.001) and inferior quadrant (P = 0.006) vessel densities differed significantly. Global retinal nerve fiber layer thickness did not differ significantly between groups 1 and 2 (112.83±14.71 versus 111.45±12.74 µm, respectively; P = 0.692). Group 1, however, had significantly higher superior, nasal, and inferior quadrant, and significantly lower temporal quadrant retinal nerve fiber layer thickness (P<0.001, for all). CONCLUSIONS Concerning the impact of probable cryptogenic organizing pneumonia-induced hypoxia on ocular tissues, optical coherence tomography angiography assessments of retinochoroidal and optic nerve head microcirculation could be employed as a biomarker for cerebral microcirculation.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye.
| | - Aydın Balcı
- Department of Chest Diseases, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Mustafa Doğan
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - İbrahim Ethem Ay
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Seray Yörükoğlu Kayabaş
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Uğur Büyükokudan
- Department of Public health, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
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Zhang Z, Driskill E, Chi J, Duensing I, Cui Q. The impact of Behcet syndrome on total knee arthroplasty outcomes: a retrospective matched cohort study. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05850-6. [PMID: 37249630 DOI: 10.1007/s00264-023-05850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Articu lar involvement is a common manifestation of Behcet syndrome (BS), which can eventually result in significant arthralgia and necessitate total knee arthroplasty (TKA). However, outcomes of BS patients after TKA are still poorly documented in the literature. The purpose of this study was to evaluate BS as a potential risk factor for complications after TKA. METHODS BS patients undergoing primary TKA were identified from the PearlDiver Mariner database from 2010 to 2021 and compared to 10:1 matched controls. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. Ninety-day emergency department (ED) visit and inpatient readmission were also documented. RESULTS A total of 4286 patients undergoing primary TKA were queried, of which 390 had BS. Patients with BS demonstrated significantly higher rates of medical complications, including deep venous thrombosis. The rates of surgical complications were similar between the two groups with the exception of periprosthetic instability, aseptic loosening, and wound complications in BS patients. Additionally, a significantly higher rate of ED visits but markedly lower rates of 90-day readmissions were noted in patients with BS. CONCLUSION Patients with BS undergoing TKA are at higher risks of medical and surgical complications. Special considerations for a unique postoperative course with the higher complications should be made. It is crucial for orthopedic surgeons and patients alike to consider these risks when determining the expected course after TKA for patients with BS.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Ian Duensing
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
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Scoping beyond pulmonary artery involvement; pulmonary involvement in Behcet's disease; a retrospective analysis of 28 patients. Clin Rheumatol 2023; 42:849-853. [PMID: 36326947 DOI: 10.1007/s10067-022-06423-5] [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: 04/04/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Pulmonary involvement other than pulmonary artery involvement in Behcet's disease still remains an area of investigation. The aim of this study was to evaluate pulmonary involvement associated with Behcet's disease. METHOD We retrospectively investigated all Behcet's disease patients in terms of pulmonary involvement. Twenty-eight patients, whose radiologic examinations were consistent with Behcet's disease-related involvement after excluding other possibilities, were included in this study. Data regarding demographic characteristics, other clinical components of Behcet's disease, treatment modalities, and types of pulmonary involvement were analyzed. RESULTS Pulmonary involvement was seen more common in male (82.1% vs 17.9%). Mean age for Behcet's disease diagnosis was found 32 years (SD 10.9) and mean age for pulmonary involvement was calculated 37 years (SD 11.4). Deep vein thrombosis (DVT) was the most common associated vascular involvement (53.6%). In our study population, alveolar hemorrhage and/or ground glass appearance were seen in 46.4% (13/28) of BD patients with pulmonary involvement. Totally, pulmonary artery aneurysm (PAA), small-sized pulmonary vasculitis (sPV), and pulmonary thrombosis (PT) were seen in 7 (25%), 13 (46.3%), and 18 (64.4%) of patients, respectively. Intracardiac thrombosis (ICT) in the right ventricle was present in 5 patients. Cyclophosphamide (CYC) was the most common preferred agent (78%) followed by azathioprine (AZA) in the first line. Warfarin was used in 18 patients. Overall mortality was seen in 3 patients: 1 due to PAA bleeding and others with unknown causes. CONCLUSION Despite the importance of pulmonary artery involvement and pulmonary thrombosis in Behcet's disease, small-sized pulmonary vasculitis in the form of small vessel involvement is generally overlooked. Our study findings have shown that alveolar hemorrhage and/or ground-glass appearance in the absence of pulmonary artery aneurysm and pulmonary thrombosis are seen commonly as well. Key Points • The characteristics of pulmonary small vasculature involvement in Behcet's disease which is still an area of investigation warrant further attention. • The clinician should bear in mind that the spectrum of pulmonary involvement in Behcet's disease may be variable, but an extensive work up is still of great importance especially in atypical cases.
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Ghembaza A, Boussouar S, Saadoun D. [Thoracic manifestations of Behcet's disease]. Rev Mal Respir 2022; 39:523-533. [PMID: 35659162 DOI: 10.1016/j.rmr.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).
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Affiliation(s)
- A Ghembaza
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France
| | - S Boussouar
- Cardiovascular and Thoracic Imaging Unit, hôpital Pitié Salpêtrière, AP-HP, Paris, France; Inserm, laboratoire d'imagerie biomédicale, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - D Saadoun
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France.
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Ahmed AA, Tharwat S, Batouty NM, El Bahy A, Tawfik AM, Shahin DA. Cardiac magnetic resonance imaging in patients with Behçet's disease. Adv Rheumatol 2021; 61:74. [PMID: 34876236 DOI: 10.1186/s42358-021-00230-3] [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: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behçet's disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients. METHODS This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI. RESULTS At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities. CONCLUSION BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.
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Affiliation(s)
- Ali A Ahmed
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt.
| | - Nihal M Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed El Bahy
- Mansoura University Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed M Tawfik
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Dina A Shahin
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
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Alkhurassi HF, Ocheltree MR, Alsomali A, Alqunfoidi RA, Saadallah A. Pleural Effusion Presenting in a Young Man With Behcet's Disease. Cureus 2020; 12:e10273. [PMID: 32923298 PMCID: PMC7478535 DOI: 10.7759/cureus.10273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Behcet's disease (BD) is a rare multisystem chronic vasculitis of variable clinical presentation and unknown origin. Pulmonary involvement in BD is uncommon, with pleural effusion being an even rarer and difficult to diagnose manifestation. Herein, we report a challenging case of a young man who presented with recurrent pleural effusion and hepatic vein thrombosis and a recent history of papilledema with idiopathic intracranial hypertension. The patient was hospitalized for diagnostic and therapeutic thoracocentesis. Biochemistry and cytological analysis showed an exudative aspect of the collected pleural fluid with lymphocyte-dominated cytology. A multidisciplinary discussion was held, and thorough investigation was carried out to rule out malignant and infectious etiologies, among other differentials. During the second hospitalization, the patient complained of genital ulcers, which were verified to be recurrent along with oral ulcers. The diagnosis of BD was established based on the International Classification Criteria for BD, and the symptoms improved significantly upon using colchicine and immune-suppressive drugs.
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Affiliation(s)
| | | | - Ahlam Alsomali
- Internal Medicine/Geriatric, International Medical Center, Jeddah, SAU
| | - Reem A Alqunfoidi
- Internal Medicine/Hematology, International Medical Center, Jeddah, SAU
| | - Asmaa Saadallah
- Internal Medicine, International Medical Center, Jeddah, SAU
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Abstract
Anticoagulation in venous thrombosis associated with Behçet disease (BD) is controversial. We herein report a 47-year-old woman with vessel thrombosis and pulmonary artery aneurysm (PAA) associated with BD who died of massive hemoptysis under oral anticoagulant. Although she was initially diagnosed with oral contraceptive-induced venous thromboembolism, a subsequent investigation led to a diagnosis of BD. Follow-up computed tomography (CT) showed persistent thrombus, so anticoagulant was continued for persistent thrombus. She died of massive hemoptysis after the development of PAA was identified on follow-up CT during the period of anticoagulation. Great care to prevent bleeding events is required when administering anticoagulants for BD with vessel thrombosis.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Ryosuke Narui
- Department of Cardiology, The Jikei University School of Medicine, Japan
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Japan
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Thoracic Complications in Behçet's Disease: Imaging Findings. Can Respir J 2020; 2020:4649081. [PMID: 32566055 PMCID: PMC7275231 DOI: 10.1155/2020/4649081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.
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Al Bshabshe A, Assiri A, Somaily M. Massive hemoptysis secondary to Behçet's aneurysm controlled with endobronchial balloon lung isolation: Case report and review of literature. Respir Med Case Rep 2020; 30:101105. [PMID: 32518747 PMCID: PMC7270600 DOI: 10.1016/j.rmcr.2020.101105] [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: 12/24/2019] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/12/2022] Open
Abstract
Behçet's disease (BD) is a multisystem disorder with various clinical presentations. Herein, we present a lethal complication associated with pulmonary artery aneurysm due to BD, resulting in massive hemoptysis that was controlled using endobronchial balloon lung isolation.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Internal Medicine, Critical Care Division, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Amer Assiri
- Department of Medicine Division of Critical Care, King Khalid University Medical City, Abha, Saudi Arabia
| | - Mansour Somaily
- Department of Medicine Rheumatology Division, King Khalid University Medical City, Abha, Saudi Arabia
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Muratore F, Pipitone N, Salvarani C, Schmidt WA. Imaging of vasculitis: State of the art. Best Pract Res Clin Rheumatol 2016; 30:688-706. [DOI: 10.1016/j.berh.2016.09.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
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Recurrent Interstitial Pneumonitis in a Patient with Entero-Behçet's Disease Initially Treated with Mesalazine. Case Rep Rheumatol 2016; 2016:5636489. [PMID: 27429824 PMCID: PMC4939210 DOI: 10.1155/2016/5636489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022] Open
Abstract
A 65-year-old man with entero-Behçet's disease (BD) being treated with mesalazine was presented to our hospital complaining of dyspnea. Computed tomography (CT) of the chest showed ground-glass opacities and he was initially diagnosed with mesalazine-induced interstitial pneumonitis (IP). Besides the discontinuation of mesalazine, a high dose of oral prednisolone was administered and the patient seemed to recover. However, four months later, dyspnea recurred and repeated CT revealed more extensive pulmonary infiltration despite steroid therapy. After the exclusion of infections, we suspected either a recurrence of mesalazine-induced IP or BD-related IP as a clinical manifestation of BD. The patient was treated with intravenous methylprednisolone and cyclophosphamide, followed by orally administered azathioprine, based on the assumption of underlying vasculitis. Thereafter, his condition improved. BD-related IP is an extremely rare condition with limited reports in the literature. Mesalazine-induced IP is also uncommon but the prognosis is generally good after discontinuation of mesalazine with or without steroid therapy. We discuss an extremely rare case, especially focusing on BD-related IP and mesalazine-induced IP as a potential cause of recurrent IP in a patient with entero-BD.
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Edrees A, Naguib S, El Menyawi M, Ismail I, Nagah H. Pulmonary manifestations in a group of patients with Behcet's disease. Int J Rheum Dis 2015; 20:269-275. [PMID: 26354676 DOI: 10.1111/1756-185x.12626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In this study we investigated the frequency and characteristics of pulmonary manifestations in a group of patients with Behcet's disease (BD) who were admitted to Cairo University Hospital. METHODS Fifteen patients were included in our study, 14 men (93.3%) and one woman (6.66%).Their mean age was 30.06 ± 9.8 years and the mean age of onset of BD was 23.7 ± 5.54 years. All patients were subjected to full history taking, clinical examination, plain chest X-ray and helical computed tomography (CT) study of the chest. RESULTS Pulmonary involvements were detected in 11 patients with BD, 73.3% of cases: 10 men (90.9%) and one woman (9.09%).Their mean age was 28.8 ± 8.07, the mean age of onset of BD was 23.2 ± 5.59 years and the mean disease duration until lung manifestations appear was 3.7 ± 4.8 years. The main pulmonary and constitutional symptoms in these 11 patients were as follows: dyspnea 81.8%, cough 63.6%, weight loss 63.6%, chest tightness 54.5%, hemoptysis 45%, massive hemoptysis 27.2%, fever 36.3% and expectoration 36.3. Analysis of both vascular and parenchymal lung lesions in helical CT scan in the 11 patients with BD were as follows: pulmonary artery aneurysm (PAA) occurred in 5/11 patients (45.4%), pulmonary nodules occurred in 3/11 patients (27.2%), pleural effusion occurred in 3/11 patients (27.2%), pulmonary embolism and infarction occurred in 1/11 patients (9.09%) and pneumonitis occurred in 1/11 patients (9.09%). CONCLUSION The higher frequency of pulmonary manifestations in our patients (73.3%) and the higher frequency of PAA (33.3%) could be related to the fact that this study was conducted on a group of patients who were admitted to the hospital with more severe illnesses.
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Affiliation(s)
- Amr Edrees
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sherif Naguib
- Department of Internal Medicine, Cairo University, Cairo, Egypt
| | | | - Ihab Ismail
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Hamdy Nagah
- Department of Internal Medicine, Cairo University, Cairo, Egypt
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Naguib SM, El Menyawi MM, Nabih MI, Ismail I. Pulmonary manifestations in a group of patients with Behçet’s disease. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2015. [DOI: 10.4103/1110-7782.155827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cottin V, Cordier JF, Richeldi L. Alveolar Hemorrhage. ORPHAN LUNG DISEASES 2015. [PMCID: PMC7119931 DOI: 10.1007/978-1-4471-2401-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diffuse alveolar hemorrhage (DAH) is a clinical syndrome characterized by generalized intra-alveolar bleeding originating from the pulmonary microcirculation. The finding of DAH carries an extended differential diagnosis and may be associated with a number of histopathologic patterns. The prompt recognition and diagnosis of DAH is of critical importance to the practicing clinician as accurate diagnosis and prompt initiation of therapy may dramatically improve patient outcomes. This chapter reviews the diagnosis and management of diffuse alveolar hemorrhage.
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Affiliation(s)
- Vincent Cottin
- Rare Pulmonary Diseases, Hôpital Louis Pradel, Lyon, France
| | | | - Luca Richeldi
- Respiratory Medicine, University of Southampton, Southampton, United Kingdom
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Fujimoto K, Hiraoka M, Inatomi S, Ohguro H. Association of Cryptogenic Organizing Pneumonia in Bilateral Anterior Uveitis. Case Rep Ophthalmol 2014; 5:365-72. [PMID: 25520652 PMCID: PMC4264495 DOI: 10.1159/000369125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Two female patients with histories of cancer who showed cryptogenic organizing pneumonia (COP) complications and bilateral anterior uveitis with hypopyon were examined. Both patients had suffered from COP and received intermitted systemic corticosteroid administration (SCA). The first patient, a 65-year-old woman with a history of breast cancer, showed bilateral uveitis with hypopyon. The topical corticosteroid treatment was ineffective. After SCA for the treatment of COP was started, the hypopyon gradually dissipated. Upon termination of SCA, uveitis relapses were controlled by renewed SCA. The other patient, a 69-year-old woman with a history of ovarian cancer, showed bilateral anterior uveitis with hypopyon. Her intraocular outcome did not improve by the topical corticosteroid administration, but SCA that was applied to treat COP led to remission of uveitis. Imaging examinations, biochemical analysis, symptoms or HLA-B27 antigen screenings in either patient did not explain the development of uveitis. Bilateral anterior uveitis is commonly related to autoimmune disease or systemic syndrome. We report two cases with COP that developed bilateral anterior uveitis with hypopyon resistant to topical administration but responsive to systemic administration of corticosteroid. These findings suggest that COP can be associated with the etiology of anterior uveitis.
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Affiliation(s)
| | - Miki Hiraoka
- *Miki Hiraoka, MD, PhD, S1 W16 Chuo-ku, Sapporo, Hokkaido 060-8543 (Japan), E-Mail
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A Behcet's Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism. Case Rep Pulmonol 2013; 2013:492321. [PMID: 23853733 PMCID: PMC3703321 DOI: 10.1155/2013/492321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/04/2013] [Indexed: 11/30/2022] Open
Abstract
Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet's disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet's disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2 × 1.6 cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet's disease.
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Pipitone N, Versari A, Hunder GG, Salvarani C. Role of imaging in the diagnosis of large and medium-sized vessel vasculitis. Rheum Dis Clin North Am 2013; 39:593-608. [PMID: 23719077 DOI: 10.1016/j.rdc.2013.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In large-vessel vasculitis, imaging studies are useful to document temporal artery involvement and crucial to show large-vessel involvement. Color Doppler sonography, magnetic resonance, and computed tomography show early vasculitic lesions. Angiography delineates later vascular complications well. Color Doppler sonography, magnetic resonance angiography, and computed tomography angiography can also be used to show vascular luminal changes. Positron emission tomography is very sensitive in detecting large-vessel inflammation. Imaging procedures can also be used to monitor the course of large-vessel vasculitis. In medium-vessel vasculitis, imaging studies can be used to show both vascular changes and internal organ changes.
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Affiliation(s)
- Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 42123, Italy
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Bilgin G, Sungur G, Kucukterzi V. Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up. Respir Med 2013; 107:466-71. [DOI: 10.1016/j.rmed.2012.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 10/27/2022]
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Mehta AA, Jose W, Balamugesh, Christopher DJ. Right hilar mass with hemoptysis: An unusual presentation of uncommon disorder. Lung India 2011; 28:306-8. [PMID: 22084550 PMCID: PMC3213723 DOI: 10.4103/0970-2113.85698] [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: 11/22/2022] Open
Abstract
Common differential diagnosis of lung and hilar opacity includes infectious pathology or a mitotic lesion. Behcet's disease (BD) is a rarely diagnosed disease in Indian subcontinent. BD is a multisystem inflammatory disorder that presents with recurrent orogenital ulceration, uveitis, and erythema nodosum. We present here the case of a patient who presented with recurrent hemoptysis with radiological picture of hilar mass, during the evaluation of which the diagnosis of BD was established.
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Affiliation(s)
- Asmita A Mehta
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Abstract
Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown; possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored therapeutic agent in this regard. Antibiotics have no proven role in HSS while anticoagulants and thombolytic agents are generally contraindicated due to an increased risk of fatal hemorrhage. However, their use may be considered with great care under special circumstances, for instance, intracardiac thrombi or massive pulmonary embolism. For cases of massive hemoptysis due to large pulmonary aneurysms or those with lesions confined to one segment or one lung, lobectomy or pneumectomy can be carried out. However, surgical risks merit serious consideration and must be discussed with the patient. Transcatheter arterial embolization has emerged as a less invasive alternative to surgery in selected cases of HSS. Overall, patients with HSS have a poor prognosis and aneurysmal rupture is the leading cause of death. However, early diagnosis and timely intervention is crucial in improving the prognosis. There is a need to clearly elucidate the genetic, etiologic and pathologic basis for HSS in the future. Although most of the evidence put forward to refute the role of an infectious agent in the etiology and pathogenesis of HSS is based on negative blood and other body fluid cultures, more robust objective assessment is needed through the use of electron microscopy or 16 sRNA studies. The development of better therapeutic agents is also needed to address and prevent the serious consequences arising from pulmonary arterial aneurysms seen in BD and HSS. Also, the issue of anticoagulation in these patients is challenging and requires further deliberation.
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Affiliation(s)
- Umair Khalid
- Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Taimur Saleem
- Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
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Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN. Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 2010; 3:67-75. [PMID: 19561910 PMCID: PMC2700454 DOI: 10.4103/1817-1737.39641] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 01/13/2008] [Indexed: 12/20/2022] Open
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) was first described in the early 1980s as a clinicopathologic syndrome characterized symptomatically by subacute or chronic respiratory illness and histopathologically by the presence of granulation tissue in the bronchiolar lumen, alveolar ducts and some alveoli, associated with a variable degree of interstitial and airspace infiltration by mononuclear cells and foamy macrophages. Persons of all ages can be affected. Dry cough and shortness of breath of 2 weeks to 2 months in duration usually characterizes BOOP. Symptoms persist despite antibiotic therapy. On imaging, air space consolidation can be indistinguishable from chronic eosinophilic pneumonia (CEP), interstitial pneumonitis (acute, nonspecific and usual interstitial pneumonitis, neoplasm, inflammation and infection). The definitive diagnosis is achieved by tissue biopsy. Patients with BOOP respond favorably to treatment with steroids.
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Affiliation(s)
- Sara Al-Ghanem
- Department of Radiology, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Pulmonary artery aneurysms in Behçet’s disease. Rheumatol Int 2009; 30:1401-3. [DOI: 10.1007/s00296-009-1092-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Ning-Sheng L, Chun-Liang L, Ray-Sheng L. Bronchiolitis obliterans organizing pneumonia in a patient with Behçet's disease. Scand J Rheumatol 2009; 33:437-40. [PMID: 15794207 DOI: 10.1080/03009740410006187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 55-year-old male presented a productive cough, haemoptysis, and intermittent fever for 2 weeks. He was diagnosed as having Behcet's disease (BD) with manifestations of recurrent oral ulcers, genital ulcers, erythema nodosum, a gastro/duodenal ulcer, colon ulcers, and folliculitis. After admission, a chest X-ray showed bilateral ill-defined patches. Subsequent chest computerized tomography revealed multiple patchy consolidations over the left and right lower lobes. Because of poor response to oxacillin antibiotic treatment, an open lung biopsy was arranged. Bronchiolitis obliterans organizing pneumonia (BOOP) was diagnosed. Methylprednisolone pulse therapy, followed by prednisolone and cyclophosphamide maintenance, was prescribed. The patient responded well, with clinical and radiological resolution. Early diagnosis with proper treatment is crucial in the management of this lethal pulmonary disease.
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Affiliation(s)
- L Ning-Sheng
- Sections of Allergy, Immunology, Rheumatology, Department of Medicine, DaLin Tzu Chi Buddhist Hospital, Taiwan, ROC.
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Ozge C, Calikoğlu M, Yildiz A, Türsen U, Tamer L. Bilateral pulmonary artery aneurysms with protein C and protein S deficiency in a patient with Behçet's disease. Scand J Rheumatol 2009; 33:52-4. [PMID: 15124944 DOI: 10.1080/03009740310004694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Behçet's disease is a chronic inflammatory disorder of unknown aetiology, characterized by recurrent attacks. Pulmonary artery aneurysm is a rare but serious complication of Behçet's disease. We describe a patient with Behçet's disease and protein C and S deficiency who developed bilateral pulmonary artery aneurysms.
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Affiliation(s)
- C Ozge
- Department of Chest Disease, Mersin University School of Medicine, Mersin, Turkey.
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Pipitone N, Salvarani C. Role of imaging in vasculitis and connective tissue diseases. Best Pract Res Clin Rheumatol 2009; 22:1075-91. [PMID: 19041078 DOI: 10.1016/j.berh.2008.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Imaging techniques play a pivotal role in securing the diagnosis of large vessel vasculitis, and in demonstrating internal organ involvement in connective tissue diseases. In large vessel vasculitis, angiography is useful in demonstrating vessel stenoses or aneurysms. However, angiography is unable to reveal initial lesions such as vessel wall oedema and thickening, and is thus not useful to make an early diagnosis. In contrast, colour Doppler ultrasonography, computerized tomography angiography, and magnetic resonance imaging/angiography are able to delineate both the vessel wall and the lumen. Therefore, they may show vessel wall alterations when the lumen is still unaffected on angiography. 18fluorodeoxyglucose positron emission tomography does not visualize the vessel wall, but is very sensitive in revealing inflamed vessels. All of these investigations have also been used to follow up patients over time and to monitor response to treatment. In connective tissue diseases, imaging techniques are particularly useful to study internal organs, especially the brain and lung. Magnetic resonance imaging is the investigation of choice to detect and monitor brain disease, while computerized tomography is the best procedure for lung disease. However, since most imaging findings are not entirely specific for any given condition, it is important to interpret the results of imaging in the broader clinical context.
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Affiliation(s)
- Nicolò Pipitone
- Department of Rheumatology, Arcispedale Santa Maria Nuova, Viale Risorgimento, 80 42100 Reggio Emilia, Italy
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Chiari E, Fracassi F, D'Aloia A, Vizzardi E, Zanini G, Rocca P, Metra M, Cas LD. Right Ventricular Thrombus and Pulmonary Thromboembolism/Thrombosis in Behçet's Disease: A Case Report. J Am Soc Echocardiogr 2008; 21:1079. [DOI: 10.1016/j.echo.2007.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Indexed: 12/14/2022]
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Successful cyclophosphamide therapy with complete resolution of pulmonary artery aneurysm in Hughes–Stovin syndrome patient. Clin Rheumatol 2008; 27:1455-8. [DOI: 10.1007/s10067-008-0951-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
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Celenk C, Aydin F, Unsal M. Pulmonary alterations in Behcet's disease. Eur J Radiol 2008; 70:317-9. [PMID: 18337040 DOI: 10.1016/j.ejrad.2008.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 01/11/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to demonstrate pulmonary alterations (PA) in patients with Behcet's disease by using CT. MATERIALS AND METHODS CTs of 50 patients with Behcet's disease and 20 others in a control group have been evaluated retrospectively for PA (septal, reticular, nodular, atelectatic opacities). RESULTS Eight out of 50 patients (16%) with Behcet's disease showed PA. Three out of 20 (15%) in the control group showed PA. No differences were observed between Behcet's disease patients and the control group regarding pulmonary alterations (p=0.917). No differences were observed in the disease duration, ages and sex in either group in those with and without PA. CONCLUSION Pulmonary alterations can be seen in patients with Behcet's disease, but these alterations are not significant.
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Affiliation(s)
- Cetin Celenk
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Tip Fakültesi, Radyoloji, Samsun, Turkey.
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Kojuri J, Aslani A, Shahrzad S. A large pulmonary artery pseudoaneurysm in a patient with Behcetʼs disease. J Cardiovasc Med (Hagerstown) 2007; 8:1073-5. [DOI: 10.2459/jcm.0b013e328028fe5e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Emad Y, Ragab Y, Shawki AEH, Gheita T, El-Marakbi A, Salama MH. Hughes–Stovin syndrome: is it incomplete Behçet’s? Clin Rheumatol 2007; 26:1993-6. [PMID: 17457658 DOI: 10.1007/s10067-007-0609-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 03/13/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
In this report, we described two male patients with Hughes-Stovin syndrome. The first patient was a 26-year-old male who initially presented with deep vein thrombosis (DVT) in the right lower limb followed shortly by hemoptysis. Pulmonary CT angiography revealed bilateral pulmonary artery aneurysms secondary to underlying pulmonary vasculitis. While the second case was a 16-year-old male patient who initially presented with generalized fits due to sagittal sinus thrombosis and later followed by DVT in the left lower limb. Pulmonary CT angiography showed small pulmonary artery aneurysms with thrombosis of peripheral pulmonary artery branches. Both patients were treated successfully with steroids and immunosuppressive therapy and showed clinical improvement.
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Affiliation(s)
- Yasser Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Hamzaoui K, Chelbi H, Kamoun M, Dhifallah IB, Hamzaoui A. Increased endothelin-1 levels of BAL fluid in patients with Behçet's disease. Mediators Inflamm 2007; 2007:93726. [PMID: 17497041 PMCID: PMC1852888 DOI: 10.1155/2007/93726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 01/13/2007] [Accepted: 01/16/2007] [Indexed: 11/18/2022] Open
Abstract
Objective and background. Pulmonary aneurysms and thrombosis constitute a significant cause of morbidity and mortality in Behçet's disease (BD). Various factors have been studied to explore the pathogenesis of vascular involvement in BD. As endothelin (ET) is known for its potent vasoconstrictor and proinflammatory properties, we supposed that it is involved during the inflammatory process of BD pulmonary vasculitis. Methods. To investigate the role of ET in BD, ET-1 concentrations were measured in bronchoalveolar lavage fluid (BALF) of 18 nonsmoking BD patients with pulmonary manifestations and 12 control subjects. Immunoreactivity of ET-1 was also evaluated in alveolar macrophages (AMs) cytoplasm. Results. ET-1 levels in BD-BALF were significantly higher than those of controls. ET-1 levels were correlated with the number of alveolar macrophages, but not with BAL-CD4/CD8 ratio. ET-1-immunoreactivity was found mainly in AM of BD-BAL. Conclusions. Increased ET-1 production from AM is associated with pulmonary BD manifestations.
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Affiliation(s)
- Kamel Hamzaoui
- Homeostasis and Cell Dysfunction Unit Research 99/UR/08-40, Medicine University of Tunis, Tunis 1007, Tunisia
- *Kamel Hamzaoui:
| | - Hanene Chelbi
- Homeostasis and Cell Dysfunction Unit Research 99/UR/08-40, Medicine University of Tunis, Tunis 1007, Tunisia
| | - Mariam Kamoun
- Homeostasis and Cell Dysfunction Unit Research 99/UR/08-40, Medicine University of Tunis, Tunis 1007, Tunisia
| | - Imen Ben Dhifallah
- Homeostasis and Cell Dysfunction Unit Research 99/UR/08-40, Medicine University of Tunis, Tunis 1007, Tunisia
| | - Agnes Hamzaoui
- Homeostasis and Cell Dysfunction Unit Research 99/UR/08-40, Medicine University of Tunis, Tunis 1007, Tunisia
- Pneumology Hospital A. Mami, Department of Paediatric and Respiratory Diseases, Pavillon B, Ariana 2080, Tunisia
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Gökoğlu F, Yorgancioğlu ZR, Ustün N, Ardiç FA. Evaluation of pulmonary function and bicycle ergometry tests in patients with Behçet's disease. Clin Rheumatol 2007; 26:1421-5. [PMID: 17216370 DOI: 10.1007/s10067-006-0508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 11/25/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
Behçet's disease (BD) has well-defined pulmonary complications, but cardiopulmonary exercise testing and the strength of the respiratory muscles have not been studied in detail. We aimed to investigate the pulmonary functions tests, inspiratory and expiratory muscle strength and endurance, cardiopulmonary exercise test response, and the relationship of these parameters in patients with BD. Forty BD patients and 20 healthy control subjects were recruited for this study. Mean age was 32.95 +/- 7.66 years for the BD group and 33.85 +/- 6.63 years for the control group with no statistically significant difference. The ratios of slight obstructive ventilatory impairment were 32.5% for the BD group. When the values of pulmonary function tests were compared, no statistically significant difference was found in FEV(1)/FVC (Forced expiratory volume during the first second/forced vital capacity), or maximal midexpiratory flow rate (all in percent) values between patient and control groups. Maximal inspiratory and expiratory pressures, peak expiratory flow rate (in percent) and maximal voluntary ventilation (in percent) values were significantly lower than those of the control group. Body's consumption of peak oxygen (VO(2peak)), oxygen consumption (milliliters per kilogram per minute), anaerobic threshold (AT), maximum exercise ventilation (VE(max)), work load values, and exercise test time in the bicycle exercise test were significantly higher in control groups than in patients with BD. The values of heart rate reserve, breathing reserve, and VE/VCO(2) at the AT of BD patients were within normal limits We conclude that respiratory and aerobic exercise may be recommended to improve respiratory muscle strength and endurance as well as the aerobic capacity and maximal ventilatory capacity in patients with BD.
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Affiliation(s)
- Figen Gökoğlu
- First Department of Physical Medicine and Rehabilitation, Ministry of Health Ankara Education and Research Hospital, 06340, Ankara, Turkey.
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Emad Y, Abdel-Razek N, Gheita T, el-Wakd M, el-Gohary T, Samadoni A. Multislice CT pulmonary findings in Behçet's disease (report of 16 cases). Clin Rheumatol 2006; 26:879-84. [PMID: 17024317 DOI: 10.1007/s10067-006-0408-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 07/08/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
Pulmonary artery aneurysm is the best-defined type of pulmonary disease in Behçet's disease (BD) with an important morbidity and mortality. The objective of this study was to assess the contribution of high-resolution dynamic chest CT imaging for one of the most serious aspects of BD: pulmonary artery aneurysm and other pulmonary parenchymal involvement. Sixteen BD patients were recruited for this study, (14 men, 87.5%, and 2 women, 12.5%). All patients fulfilled the 1990 American College of Rheumatology criteria for classification of BD [International Study Group for Behçet's Disease, Lancet 335:1078-1080, (1990)]. All patients underwent thorough history taking, full clinical examination, and routine laboratory investigations. Plain chest X-rays and pulmonary CT angiography were performed on all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Pulmonary vascular abnormalities were as follows: pulmonary artery aneurysms of varying sizes in nine patients (56.3%), main pulmonary artery ectasia in two patients (12.5%), pulmonary artery embolism in two patients (12.5%), venacaval thrombosis in seven patients (43.8%), and pulmonary venous varices in four patients (25%). Pulmonary parenchymal abnormalities were as follows: three patients (18.8%) with mild central bronchiectasis, one patient (6.3%) with atelectasis, one patient (6.3%) with subpleural nodule, and four patients (25%) with interstitial lung disease. Eight of the male patients were smokers. Multislice CT is useful in demonstrating the entire spectrum of thoracic manifestations of BD. Multislice CT is noninvasive and provides excellent delineation of the vessel lumen and wall and perivascular tissues, as well as detailed information concerning the lung parenchyma, pleura, and mediastinal structures.
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Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Kim HK, Yong HS, Oh YW, Shim JJ, Kim HK, Kang EY. Behçet Disease Complicated by Diffuse Alveolar Damage. J Thorac Imaging 2005; 20:55-7. [PMID: 15729125 DOI: 10.1097/01.rti.0000139392.33761.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an extremely rare case of Behçet disease complicated by diffuse alveolar damage, which was fatal in this patient. It manifested as progressive diffuse ground-glass attenuation in both lungs on chest radiographs and high-resolution CT. Ground-glass attenuation was confirmed histopathologically as diffuse alveolar damage without identified etiology by open lung biopsy.
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Affiliation(s)
- Hee-Kyung Kim
- Department of Diagnostic Radiology, College of Medicine, Korea University, Korea University Guro Hospital, Seoul, Korea
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Hiller N, Lieberman S, Chajek-Shaul T, Bar-Ziv J, Shaham D. Thoracic Manifestations of Behçet Disease at CT. Radiographics 2004; 24:801-8. [PMID: 15143229 DOI: 10.1148/rg.243035091] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Behçet disease is a multisystemic and chronic inflammatory disorder of unknown cause that is characterized by recurrent oral and genital ulcerations, ocular manifestations, and additional clinical manifestations in multiple organ systems. Behçet disease involving the chest can manifest as a wide spectrum of abnormalities. Although conventional chest radiography is commonly used for initial assessment, spiral computed tomography can demonstrate the entire spectrum of thoracic manifestations of Behçet disease, including abnormalities of the vessel lumen and wall, perivascular tissues, lung parenchyma, pleura, and mediastinal structures. Aneurysms of the pulmonary arteries, with or without thrombosis, are a typical manifestation of Behçet disease. Other manifestations include thrombosis, vasculitis, hemorrhage, infarction, and inflammation. Familiarity with these manifestations can be useful in the diagnosis of Behçet disease, helping to determine the cause of symptoms in patients who present with hemoptysis and guide the choice of appropriate therapy.
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Affiliation(s)
- Nurith Hiller
- Department of Radiology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel 91120
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36
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Yoon YH, Kim KH, Baek WK, Kim JT, Shon KH, Kim YS, Han HS, Cho JH. Pulmonary artery pseudoaneurysm in a patient with Behçet disease. J Thorac Cardiovasc Surg 2004; 127:590-2. [PMID: 14762379 DOI: 10.1016/j.jtcvs.2003.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yong Han Yoon
- Department of Cardiovascular Thoracic Surgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea.
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Abstract
OBJECTIVE To present a case of pulmonary artery aneurysms (PAAs) in a child with Behcet's disease (BD). NATURE OF THE STUDY: Case report and review of the literature. MATERIALS AND METHODS The patient had a complete autopsy, drug screen and serological testing. A medical history was obtained and the literature was reviewed. RESULTS A 10-year-old African-American boy had massive hemoptysis while at home and died shortly thereafter in the emergency department of a local hospital. He had had two other episodes of hemoptysis in the past 2 months. At autopsy, he had bilateral inflammatory aneurysms of the lower lobe branches of the pulmonary arteries. The left aneurysm had eroded into the adjacent bronchus and accounted for the fatal hemoptysis. The right ventricle had endocardial fibrosis. Systemic vasculitis was absent. The child did not have oral, genital, eye or skin lesions at autopsy, or by clinical history. Based on the autopsy findings, a diagnosis of BD was made. CONCLUSIONS We present the very unusual case of a 10-year-old African-American boy who died from hemoptysis resulting from bilateral pulmonary aneurysms caused by BD.
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Affiliation(s)
- Stephen D Cohle
- Spectrum Health Blodgett Campus, 1840 Wealthy Street SE, Grand Rapids, MI 49506, USA.
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39
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Abstract
Our knowledge about pulmonary complications of Behçet's disease continues to evolve, but we need controlled trials for the management of the disease. The main goal should be to elucidate the pathogenesis and standardize the management according to the underlying pathologic process.
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Affiliation(s)
- Feyza Erkan
- Department of Pulmonary Medicine, Istanbul Medical Faculty, University of Istanbul, 34 390 Capa-Istanbul, Turkey.
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40
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Abstract
Interstitial lung disease often starts as a reaction to a causative insult or antigen, such as an inhaled environmental organic or inorganic dust and autoimmune mediated injury. When no underlying cause can be found, the inflammatory change in the gas exchanging parts of the lungs and associated fibrosis is called idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis). The common causes of pulmonary fibrosis can be classified as granulomatosus, nongranulomatous, neoplastic, and iatrogenic. There are other multisystem disorders not included in this classification that are associated with interstitial lung disease. Amyloidosis, Behcet disease, Kikuchi disease, and Whipple disease are such multiorgan disorders that involve the lungs.
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Affiliation(s)
- O P Sharma
- University of Southern California School of Medicine, 1200 North State Street, Los Angeles, CA 90033, USA.
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Affiliation(s)
- F Erkan
- Division of Pneumology, Istanbul Medical Faculty, University of Istanbul, Turkey.
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