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Smaali J, Charef A, Bamous M, Fatihi J, Amezian T. Anasarca Revealing Severe Cardiac Involvement Due to Behçet's Disease (BD): A Case Report. Cureus 2023; 15:e34532. [PMID: 36879693 PMCID: PMC9984977 DOI: 10.7759/cureus.34532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Behçet's disease (BD) is a systemic vasculitis which is most often manifested by recurrent oral aphthosis, genital aphthosis, and ocular involvement with sometimes visceral damage, in particular neurological, digestive, vascular, or renal. We report the case of a 21-year-old man admitted for anasarca who revealed severe cardiac involvement associating endomyocardial fibrosis, intracardiac thrombi and involvement of the tricuspid valve in the context of BD diagnosed a posteriori. Cardiac involvement is exceptional during BD, especially as a mode of entry into the disease. It can be particularly severe, hence the need for early diagnosis, rapid and sometimes aggressive management. Close monitoring is also necessary in order to watch for the occurrence of visceral manifestations, particularly in young patients.
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Affiliation(s)
- Jihane Smaali
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR.,Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, MAR
| | - Amal Charef
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Mehdi Bamous
- Cardiac Surgery, Mohammed V Military Training Hospital, Rabat, MAR
| | - Jamal Fatihi
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
| | - Taoufik Amezian
- Internal Medicine, Mohammed V Military Training Hospital, Rabat, MAR
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Akbay Ş, Ekici F, Çomak E. A rare complication of Behçet's disease in a 12-year-old girl: a large intracardiac thrombosis. Cardiol Young 2022; 33:1-3. [PMID: 36377415 DOI: 10.1017/s1047951122003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behcet's disease is a multi-systemic inflammatory disease with a clinical spectrum as a triple complex of recurrent oral, genital ulcers, and uveitis. Cardiac involvement in patients with Behcet's disease is extremely rare and often associated with poor prognosis. Behcet's disease should be considered in the differential diagnosis of right ventricular mass especially in young adults, even there is no typical clinical features of Behcet's disease. In this case, a 12-year-old girl who admitted with chest pain and haemoptysis and then was diagnosed with intracardiac thrombus related to Behcet's disease during follow-up was described.
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Affiliation(s)
- Şenay Akbay
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Filiz Ekici
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Elif Çomak
- Pediatric Rheumatology, Akdeniz University Medical School, Antalya, Turkey
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Briosa A, Gomes AC, CastelBranco A, Cunha M, Sousa S, Almeida AR, Calhau P, Pereira H. Behçet's disease: a case report about a rare cause of intra-cardiac mass. Eur Heart J Case Rep 2021; 5:ytab299. [PMID: 34632262 PMCID: PMC8497885 DOI: 10.1093/ehjcr/ytab299] [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: 12/08/2020] [Revised: 02/03/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intra-cardiac masses are always a challenging diagnosis, especially when it involves the right side of the heart. There are multiples aetiologies that can be responsible for these masses, namely thrombosis, neoplasm, or vegetations. Occasionally, these may be related to an autoimmune process not yet diagnosed. We present a case of a 17-year-old patient with an exuberant right ventricular mass due to a not yet diagnosed Behçet's disease. The best approach and treatment for these patients remains uncertain. CASE SUMMARY The authors present a case of a 17-year-old patient with a right ventricular mass who presented as an initial manifestation of Behçet's disease. It was firstly assumed as a thrombotic mass and medicated with anticoagulation, with no resolution. After performing a cardiac magnetic resonance, the case was discussed in a multidisciplinary team, including cardiology, paediatrics, and rheumatology, and the diagnosis of Behçet's disease with cardiac complication was established. The patient started immunosuppressive therapy with clinical and echocardiographic response. DISCUSSION Behçet's disease is a multi-systemic autoimmune vasculitis that usually manifests by recurrent oral and genital ulcers as well as ocular symptoms. Cardiac manifestations are rare but important aspects of the course of the disease, especially in what concerns morbidity burden. The treatment of these cardiovascular complications is generally empirical and involves the treatment of the underlying disease.
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Affiliation(s)
- Alexandra Briosa
- Cardiology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Ana Catarina Gomes
- Cardiology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Ana CastelBranco
- Pediatric Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Margarida Cunha
- Rheumatology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Sandra Sousa
- Rheumatology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Ana Rita Almeida
- Cardiology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Paulo Calhau
- Pediatric Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta EPE, Av. Prof. Torrado da Silva, 2801-951 Almada, Portugal
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Morshedy NA, Mohammed DF, Badr FM, Teama MAEM. The pattern of cardiovascular manifestations in Egyptian Behçet’s patients and its relation to disease activity. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Behçet’s disease (BD) is also referred to as vascular BD when it frequently involves the heart and vessels. This study aimed to describe the cardiovascular manifestations in patients with BD and its correlation to disease activity. We conducted a cross-sectional study on 40 patients diagnosed with BD according to the International Criteria for Behçet’s Disease 2014. All the patients were subjected to detailed history taking, full clinical examination, lab investigations, resting electrocardiogram, trans-thoracic echocardiography, and carotid artery duplex for measuring intimal thickness, peripheral arterial and venous duplex, computed tomography pulmonary angiography, and full ophthalmological examination. Regarding the activity of the disease, it was assessed according to the score of Behçet’s Disease Current Activity Form (BDCAF).
Results
The most common cardiac manifestation was valvular lesion (67.5%) where the most frequently affected valve was the tricuspid valve (27.5%). Although 25% of patients had left ventricular diastolic dysfunction, only 5% had intracardiac masses. Approximately 52.5% of patients had vascular lesion (deep venous thrombosis 45%, arterial involvement 7.5% [as pulmonary artery thrombosis 5% and aneurysm 2.5%]). Increase in intima media thickness (IMT) was observed in 7.5% of patients, while 60% had abnormal lipid profiles. Hypercholesterolemia was the most common lipid abnormality (50%). BDCAF score range was 4–12, which was significantly correlated to multiple cardiovascular parameters as a mitral, tricuspid valve, and vascular venous involvement (p < 0.05), while not significantly correlated to lipid profile (p > 0.05).
Conclusion
Cardiovascular complications are frequent among patients with BD, even those who are asymptomatic; therefore, these complications must be screened for early detection and proper management.
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Yetkin E, Ozturk S. Cardiac Complications in Behçet's Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2165-2166. [PMID: 30054022 DOI: 10.1016/j.ultrasmedbio.2018.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/10/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, Yenisehir Hospital, Mersin, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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Pu L, Li R, Xie J, Yang Y, Liu G, Wang Y, Li Y. Characteristic Echocardiographic Manifestations of Behçet's Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:825-830. [PMID: 29373154 DOI: 10.1016/j.ultrasmedbio.2017.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to determine the characteristic echocardiographic manifestations of Behçet's disease. Ninety-seven Behçet's patients admitted to our hospital from January 2002 to December 2016 were retrospectively analyzed. There were 63 patients (64.9%) with cardiac involvement; these included 47 men (74.6%) and 16 women (25.4%). Of these 63 patients, most (74.6%) exhibited valvular lesions, especially aortic regurgitation. The primary characteristic manifestations of valves were cusp prolapse with aneurysmal changes, vegetation-like lesions and echo-free spaces within the annulus. Second (30.0%) were aortic lesions, including aortic dilation or aneurysm formation, aortic pseudoaneurysm and coronary sinus aneurysm. Other manifestations, such as cardiac thrombosis, coronary arterial pseudoaneurysm, pulmonary aneurysm and pericardial effusion, were rare. Cardiac involvement is not uncommon in Behçet's patients, especially in males, and it is characterized by valvular disease, especially aortic regurgitation. The diagnosis of Behçet's disease should be considered when evaluating patients with these characteristic echocardiographic manifestations.
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Affiliation(s)
- Lihong Pu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rongjuan Li
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Jinjie Xie
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ya Yang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guowen Liu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yueli Wang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yijia Li
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians. Autoimmun Rev 2018; 17:201-214. [DOI: 10.1016/j.autrev.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
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