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Saadoun D, Bodaghi B, Cacoub P. Behçet's Syndrome. N Engl J Med 2024; 390:640-651. [PMID: 38354143 DOI: 10.1056/nejmra2305712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- David Saadoun
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
| | - Bahram Bodaghi
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
| | - Patrice Cacoub
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
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Jung JW, Kim YE, Oh SY, Lee HJ. Neuro-Behçet Disease Presenting with Wall-Eyed Bilateral Internuclear Ophthalmoplegia Syndrome: A Case Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:88-90. [PMID: 38360522 PMCID: PMC10869429 DOI: 10.3341/kjo.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jin Wook Jung
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Young-Eun Kim
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju,
Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju,
Korea
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju,
Korea
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3
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Kidd DP. Neurological involvement by Behçet's syndrome: clinical features, diagnosis, treatment and outcome. Pract Neurol 2023; 23:386-400. [PMID: 37775123 DOI: 10.1136/pn-2023-003875] [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] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
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Messafi I, Chariba S, Maadane A, Sekhsoukh R. Unilateral Internal Jugular Vein Thrombosis Revealing Behçet's Disease: Through the Eyes of the Ophthalmologist. Neuroophthalmology 2023; 47:153-155. [PMID: 37398507 PMCID: PMC10312028 DOI: 10.1080/01658107.2023.2168016] [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: 08/05/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
Behçet's disease (BD) is a rare autoimmune disease with an unknown aetiology. It is mostly found in the ancient "silk route" (from the Mediterranean region to the Far East). BD is a vasculitis that can involve veins and arteries of all sizes. Clinical features are dominated by oral and genital aphthous ulcers and uveitis. Central nervous system manifestations include parenchymal (80%) and non-parenchymal involvement (20%). Non-parenchymal forms can include cerebral venous thrombosis. Treatment is based on anti-inflammatory, immunosuppressive and anticoagulant agents, but it remains controversial. We report a rare case of a unilateral jugular being thrombosis revealing BD in a young Moroccan male. He was admitted due to neuro-ophthalmological manifestations (diplopia, and bilateral papilloedema). A good outcome occurred after treatment with anti-inflammatory drugs and anti-coagulation.
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Affiliation(s)
- Imad Messafi
- Ophthalmology Department, Mohammed VI University Hospital, Oujda, Morocco
- Ophthalmology, Neurology and ENT Research Laboratory, Medicine and Pharmacy Faculty, Mohammed 1st University, Oujda, Morocco
| | - S. Chariba
- Ophthalmology Department, Mohammed VI University Hospital, Oujda, Morocco
- Ophthalmology, Neurology and ENT Research Laboratory, Medicine and Pharmacy Faculty, Mohammed 1st University, Oujda, Morocco
| | - A. Maadane
- Ophthalmology Department, Mohammed VI University Hospital, Oujda, Morocco
- Ophthalmology, Neurology and ENT Research Laboratory, Medicine and Pharmacy Faculty, Mohammed 1st University, Oujda, Morocco
| | - R. Sekhsoukh
- Ophthalmology Department, Mohammed VI University Hospital, Oujda, Morocco
- Ophthalmology, Neurology and ENT Research Laboratory, Medicine and Pharmacy Faculty, Mohammed 1st University, Oujda, Morocco
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5
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Tian G, Sun X, Chen Q. Arteritic Anterior Ischemic Optic Neuropathy. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_7] [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] Open
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Affiliation(s)
- Haeng-Jin Lee
- From the Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
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Neuro-Behce Disease Causing Nuclear/Fascicular Forth Nerve Palsy. J Neuroophthalmol 2021; 42:e517-e519. [PMID: 34661378 DOI: 10.1097/wno.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuro-Behce disease (NBD) has a predilection for affecting the parenchyma of the upper brainstem; however, involvement of the fourth nerve nucleus or fascicle by NBD has not been previously described. We report a case of a young man with acute right fourth nerve palsy and history of Behcet disease with an enhancing lesion in the left caudal midbrain corresponding to the left trochlear nerve nucleus/fascicle. This is the first described case of NBD producing nuclear/fascicular fourth nerve palsy. It also demonstrates an important clinicoanatomical correlate of decussation of fourth nerve fibers to the opposite side after exiting the midbrain.
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Ducloyer JB, Marignier R, Wiertlewski S, Lebranchu P. Optic neuritis classification in 2021. Eur J Ophthalmol 2021; 32:11206721211028050. [PMID: 34218696 DOI: 10.1177/11206721211028050] [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: 12/25/2022]
Abstract
Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
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Affiliation(s)
| | - Romain Marignier
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon, Auvergne-Rhône-Alpes, France
| | | | - Pierre Lebranchu
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
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Hadjadj J, Gaube G, Groh M, Paule R, Salah S, Hoogewoud F, Blanche P, Mouthon L, Monnet D, Le Jeunne C, Brézin A, Terrier B. The Clinical Spectrum and Outcome of Uveomeningitis: A Comprehensive Analysis of 110 Cases. Ocul Immunol Inflamm 2021; 30:1489-1494. [PMID: 33974484 DOI: 10.1080/09273948.2021.1898000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Uveitis can be associated with meningitis (uveomeningitis) and the inflammation shared with the central nervous system. We aimed to describe the characteristics and outcome of uveomeningitis.Methods: We retrospectively analyzed 110 consecutive adult patients with uveomeningitis.Results: The main causes of uveomeningitis were Vogt-Koyanagi-Harada (31%), syphilis (16%), sarcoidosis (12%), Behçet's disease (7%), and multiple sclerosis (5%). Sixteen percent of uveomeningitis remained of undetermined origin. Compared to etiology-matched uveitis without meningitis, patients with uveomeningitis were younger, had more frequent neurological manifestations, and had more frequent abnormal cerebral magnetic resonance imaging findings. In contrast, no ocular feature upon examination was significantly associated with the presence of meningitis. Patients with uveomeningitis were more frequently treated with immunosuppressants but uveitis relapse and systemic complications did not differ between groups.Conclusion: Uveomeningitis is associated with a limited spectrum of diseases. Meningitis does not seem to impact ocular and extraocular outcomes. Therefore, lumbar puncture should be performed on an individual basis during the diagnostic workup of uveitis.
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Affiliation(s)
- Jérome Hadjadj
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Université de Paris, Paris, France
| | - Géraldine Gaube
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Romain Paule
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Sawsen Salah
- Department of Ophthalmology, Hôpital Cochin, APHP-CUP, Paris, France
| | - Florence Hoogewoud
- Department of Ophthalmology, Hôpital Cochin, APHP-CUP, Paris, France.,Jules Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Université de Paris, Paris, France
| | - Dominique Monnet
- Université de Paris, Paris, France.,Department of Ophthalmology, Hôpital Cochin, APHP-CUP, Paris, France
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Université de Paris, Paris, France
| | - Antoine Brézin
- Université de Paris, Paris, France.,Department of Ophthalmology, Hôpital Cochin, APHP-CUP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP), Paris, France.,Université de Paris, Paris, France
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Kötter I, Lötscher F. Behçet's Syndrome Apart From the Triple Symptom Complex: Vascular, Neurologic, Gastrointestinal, and Musculoskeletal Manifestations. A Mini Review. Front Med (Lausanne) 2021; 8:639758. [PMID: 33898481 PMCID: PMC8063110 DOI: 10.3389/fmed.2021.639758] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/12/2021] [Indexed: 12/13/2022] Open
Abstract
Behçet‘s Syndrome (BS) is a variable vessel vasculitis according to the Chapel Hill Consensus Nomenclature (1) and may thus affect any organ, including major and minor arterial and venous vessels to a varying degree and with varying frequency. Although the main features of BS are recurrent oral and genital aphthous ulcers, cutaneous lesions, ocular inflammation and arthritis—major vessel and life—or organ threatening involvement of internal organs and the central and peripheral nervous system occur. In general, BS in Europe appears to form six phenotypes of clinical manifestations (2), which are (1) mucocutaneous only, (2) predominant arthritis/articular involvement, (3) vascular phenotype, (4) ocular manifestations, which are most likely associated with CNS manifestations and HLA-B51, (5) dominant parenchymal CNS manifestations (being associated with the ocular ones), and (6) gastrointestinal involvement. Mucocutaneous manifestations are present in almost all patients/all phenotypes. In the following review, we summarize the current knowledge concerning vascular, neurologic, gastrointestinal and musculoskeletal manifestations of the disease.
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Affiliation(s)
- Ina Kötter
- Division of Rheumatology and Inflammatory Rheumatic Diseases, University Hospital Hamburg Eppendorf and Clinic for Rheumatology and Immunology Bad Bramstedt, Bad Bramstedt, Germany
| | - Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital Bern, University of Bern, Bern, Switzerland
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11
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Kardum Ž, Milas Ahić J, Lukinac AM, Ivelj R, Prus V. Optic neuritis as a presenting feature of Behçet's disease: case-based review. Rheumatol Int 2020; 41:189-195. [PMID: 32860521 DOI: 10.1007/s00296-020-04690-6] [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] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
Behçet's disease (BD) is vasculitis affecting vessels of variable sizes characterized with recurrent oral and/or genital aphthous ulcers accompanied by cutaneous, ocular, articular, gastrointestinal, and/or central nervous system inflammatory lesions. The disease is characterized by recurrent attacks and remissions of different durations, which is one of the reasons why the diagnosis is, in most cases, made several years after the onset of first symptoms. We present a 24-year old male, with South Eastern European heritage, with relapsing bilateral optic neuritis as a first symptom of the disease, followed by aseptic meningitis 2 years, and vascular manifestation 3 years after onset, which finally led to the diagnosis of Behçet's disease. Vascular symptoms were thromboembolism of the right leg and aneurism of the right popliteal artery that due to the size required surgical treatment. The patient was treated with glucocorticoids, azathioprine and anti-tumor necrosis factor-alpha therapy, that proved to be the best treatment options for all manifestations of the disease. Based on our literature review, optic neuritis is a known and rare clinical feature of BD. To our knowledge, there are only several literature reports in which optic neuritis is the initial symptom of BD. Our case report and literature review emphasize the importance of recognizing optic neuritis without inflammatory eye disease as a possible presenting symptom of BD and accentuate detailed medical history review at each patient's visit.
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Affiliation(s)
- Željka Kardum
- Department of Rheumatology, Clinical Immunology and Allergology, Internal Clinic, University Hospital Osijek, J. Huttlera 4, 31000, Osijek, Croatia. .,School of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000, Osijek, Croatia.
| | - Jasminka Milas Ahić
- Department of Rheumatology, Clinical Immunology and Allergology, Internal Clinic, University Hospital Osijek, J. Huttlera 4, 31000, Osijek, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000, Osijek, Croatia
| | - Ana Marija Lukinac
- Department of Rheumatology, Clinical Immunology and Allergology, Internal Clinic, University Hospital Osijek, J. Huttlera 4, 31000, Osijek, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000, Osijek, Croatia
| | - Ružica Ivelj
- Department of Radiology, University Hospital Osijek, J. Huttlera 4, 31000, Osijek, Croatia
| | - Višnja Prus
- Department of Rheumatology, Clinical Immunology and Allergology, Internal Clinic, University Hospital Osijek, J. Huttlera 4, 31000, Osijek, Croatia.,School of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, 31000, Osijek, Croatia
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Lee D. Behçet disease: An uncommon condition with common manifestations. Nurse Pract 2019; 44:20-27. [PMID: 31498214 DOI: 10.1097/01.npr.0000580792.59356.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Behçet disease (BD) is a rare yet complicated chronic inflammatory condition related to vasculitis that may present with multiorgan involvement. BD has a number of potential clinical presentations, with painful oral and genital lesions being the most common. Outcomes of BD range from recurring, painful, transient rashes to life-threatening episodes. Primary care NPs are in a key position to develop suspicion for BD based on clinical presentation of combined manifestations. This article uses a case study to explore the diagnosis of BD.
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Affiliation(s)
- Debra Lee
- Debra Lee is a primary health care NP at Georgian Bay Family Health Team, Collingwood, Ontario
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