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Derbel A, Snoussi M, Ghribi M, Ben Hamad M, Damak C, Frikha F, Marzouk S, Bahloul Z. Recurrent intra-cardiac thrombosis: A rare manifestation of Behçet's disease. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:115-117. [PMID: 38697708 DOI: 10.1016/j.jdmv.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
Behçet's disease is a systemic vasculitis characterized by recurrent bipolar aphtosis and ophthalmic disorders. Cardiac involvement is rarely reported and could be associated to poor prognosis. Intracardiac thrombosis is exceptional and represents a therapeutic issue. We report the case of a young man admitted in internal medicine department for management of prolonged fever and recurrent mouth ulcers.
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Affiliation(s)
- Abir Derbel
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia.
| | - Mouna Snoussi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mariem Ghribi
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Mayeda Ben Hamad
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Chifa Damak
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Sameh Marzouk
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hedi Chaker hospital, 3029 Sfax, Tunisia
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Ceruti H, van de Borne P, Mirica DC. Association of endomyocardial fibrosis and minor myocarditis sequelae with intracardiac thrombus and Ebstein like valvulopathy in a patient with Behçet disease: a case report. Eur Heart J Case Rep 2024; 8:ytad631. [PMID: 38173783 PMCID: PMC10762881 DOI: 10.1093/ehjcr/ytad631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Background Cardiac complications occur in 1-6% of cases of Behçet disease (BD) with intracardiac thrombus being the most frequent complication. Endomyocardial fibrosis, less common and occasionally associated with intracardiac thrombus, is reported in <20 case reports of BD, among which, three cases are described to mimic Ebstein disease based on echocardiography. We present the first case in the literature of a 34-year-old man with BD diagnosed with multiple cardiovascular complications, highlighting the challenging diagnosis and treatment of this pathology, especially regarding anticoagulation therapy. Case summary A 34-year-old man, diagnosed with BD, presented to the Emergency Room with haemoptysis. Computed tomography study of the thorax diagnosed pulmonary arterial aneurysm with multiple arterial thrombi, associated with multiple intracardiac thrombi in the right ventricle and atrium. The echocardiography confirmed the presence of voluminous thrombi in the right ventricle and atrium and showed hypertrabeculation of the right ventricle and a high insertion of the posterior leaflet of the tricuspid valve inducing a moderate tricuspid insufficiency compatible with an Ebstein disease. The cardiac MRI later revealed right ventricular fibrosis consistent with endomyocardial fibrosis and sequelae of myocarditis, also described as BD rare cardiac manifestations. The patient had a favourable outcome under anticoagulant treatment and immunosuppressive drugs. Discussion The association of multiple cardiovascular complications can occur in a single patient with BD. The endomyocardial fibrosis in the right heart chambers acting as a substrate for thrombus formation and subsequent pulmonary embolism; fibrosis extending to the tricuspid valve inducing an Ebstein-like morphology.
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Affiliation(s)
- Hélène Ceruti
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Hopital Universitaire de Bruxelles (HUB), Route de Lennik, Hopital Erasme, Route de Lennik 808, 1070 Anderlecht, Bruxelles, Belgium
| | - Daniela-Corina Mirica
- Department of Cardiology, Hopital Delta, Boulevard du Triomphe Hopital Delta, Boulevard du Triomphe 201, 1160 Auderghem, Bruxelles, Belgium
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Nagafuchi H, Kikuchi H, Ishibash H, Maeda H, Ogino H, Kirino Y, Sawada T, Saito K, Kuwana M, Hirohata S, Ishigatsubo Y, Niimi M, Okita Y, Miyata T, Shigematsu H, Takeno M. Recommendations for the management of the vascular involvement in Behçet's disease by the Japanese National Research Committee for Behçet's disease-secondary publication. Mod Rheumatol 2023; 34:182-193. [PMID: 36658731 DOI: 10.1093/mr/road002] [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: 09/22/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to develop clinical guidelines for the management of vascular Behçet's disease (BD) by the Behçet's Disease Research Committee of the Ministry of Health, Labour and Welfare of the Japanese Government. METHODS A task force proposed clinical questions (CQs) concerning vascular BD based on a literature search. After screening, draft recommendations were developed for each CQ and brushed up in three blinded Delphi rounds, leading to the final recommendations. RESULTS This study provides recommendations for 17 CQs concerning diagnosis and differential diagnoses, assessment of disease activity, and treatment. The guidelines recommend immunosuppressive treatments, for both arterial and venous involvement with active inflammation. Anticoagulation is also recommended for deep vein thrombosis except in high-risk patients. Surgical and endovascular therapies can be optional, particularly in patients with urgent arterial lesions undergoing immunosuppression. In addition, two sets of algorithms for diagnosis and treatment are shown for arterial and venous involvement. CONCLUSIONS These recommendations are expected to serve as useful tools in the daily clinical practice of BD. This content has already been published in Japanese in the Guideline for the Management of Behçet's Disease 2020 and is submitted with permission from both the primary and secondary publishers.
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Affiliation(s)
- Hiroko Nagafuchi
- Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotoshi Kikuchi
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan
| | - Hiroyuki Ishibash
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hideaki Maeda
- Department of Cardiovascular Center, Ukima Central Hospital, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazuyoshi Saito
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Shunsei Hirohata
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Tetsuro Miyata
- Office of Medical Education, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare, Narita, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
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Atalar E, Erten S, Dogan I, Konak HE. Vascular Involvement in Behcet's Disease: An Evaluation of 147 Cases and Literature Review. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:380-386. [PMID: 37900329 PMCID: PMC10600606 DOI: 10.14744/semb.2023.89083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 10/31/2023]
Abstract
Objectives Behcet's disease (BD) is characterized by systemic vasculitis with inflammation that can affect various body organs. In BD, vasculitis primarily manifests with venous involvement, distinguishing it from other forms of systemic vasculitis. Methods We retrospectively analyzed the demographic and clinical characteristics of 147 patients diagnosed with vascular BD in our center. Results Vascular BD cases accounted for 25.0% (147 out of 589) of all BD patients. A statistically significant correlation was found between gender and vascular involvement that was seen predominantly in males (76.9%). In 71 patients, a vascular event developed during follow-up for BD, while in 76 patients the disease was diagnosed after the occurrence of a vascular event (51.7%). The most common vascular event was deep vein thrombosis in the lower extremities (69.4%). Arterial involvement was primarily observed in the pulmonary arteries (12.9%). Patients with lower extremity deep vein thrombosis tended to be younger, while those with pulmonary artery involvement were typically older. Overall, veins were affected 4.5 times more frequently than arteries. Conclusion The prevalent type of venous involvement was deep vein thrombosis in the lower extremities. Thrombotic events in BD cannot be solely attributed to abnormalities in thrombotic factors. The treatment of thrombotic events in BD remains contentious, with anticoagulant efficacy being debated and immunosuppressive therapy representing the primary treatment approach. Behcet's disease should be considered when a young male patient presents with an arterial or venous vascular event, especially if it is recurrent.
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Affiliation(s)
- Ebru Atalar
- Division of Rheumatology, Department of Internal Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Sukran Erten
- Division of Rheumatology, Department of Internal Medicine, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Türkiye
| | - Ismail Dogan
- Division of Rheumatology, Department of Internal Medicine, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Türkiye
| | - Hatice Ecem Konak
- Division of Rheumatology, Department of Internal Medicine, Ankara City Hospital, Ankara, Türkiye
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Coşkun S, Ekici Tekin Z, Güngörer V, Çelikel E, Kurt T, Polat MC, Tekgöz PN, Sezer M, Karagöl C, Kaplan MM, Öner N, Gürsu HA, Kavurt AV, Güzelküçük Z, Özbek NY, Çelikel Acar B. A case series of intracardiac thrombi and vascular involvement in pediatric Behçet's disease. Rheumatol Int 2023; 43:1161-1171. [PMID: 36890395 DOI: 10.1007/s00296-023-05292-8] [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: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
To evaluate the general characteristics of pediatric Behçet's disease (BD) patients with thrombus and to present the clinical features, treatment responses and prognosis of patients with intracardiac thrombus. The clinical characteristics and outcomes of 15 patients with thrombus among 85 pediatric BD patients followed in the Department of Pediatric Rheumatology were evaluated retrospectively. Of the 15 BD patients with thrombus, 12 (80%) were male, 3 (20%) were female. The mean age at diagnosis was 12.9 ± 1.1 years. Thrombus was present at the time of diagnosis in 12 patients (80%), while thrombus developed in three patients within the first three months after diagnosis. The most common site of thrombus was the central nervous system (n = 9, 60%), followed by deep vein thrombus (n = 6, 40%) and pulmonary artery thrombus (n = 4, 26.6%). Three male patients (20%) developed intracardiac thrombus. The overall intracardiac thrombus rate in the 85 patients was 3.5%. Two of the three patients had thrombus in the right, and one had thrombus in the left heart cavity. In addition to steroids, 2 of the 3 patients received cyclophosphamide, while the patient with thrombus localized in the left heart cavity was given infliximab. In the follow-up, the two patients with thrombus in the right heart cavity were switched to infliximab because of resistance to cyclophosphamide. Complete resolution was observed in 2 of the 3 patients on infliximab; a significant reduction in the thrombus of the other patient was achieved. Intracardiac thrombus is a rare presentation of cardiac involvement in BD. It is usually observed in males and in the right heart. Although steroids and immunosuppressive agents such as cyclophosphamide are recommended as first-line treatment, favorable outcomes can be achieved with anti-TNFs in resistant cases.
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Affiliation(s)
- Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey.
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Tuba Kurt
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Pakize Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Hazım Alper Gürsu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Ahmet Vedat Kavurt
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Zeliha Güzelküçük
- Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Namık Yaşar Özbek
- Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
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Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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Villacis-Nunez DS, West Z, Khan AY, Rodriguez F, Shane AL, Rytting H, Shashidharan S, Clifton MS, Woods G, Clabby M, Prahalad S. Successful Medical-Surgical Management of Intracardiac Thrombosis and Pulmonary Pseudoaneurysms in an Adolescent With Hughes-Stovin Syndrome. J Investig Med High Impact Case Rep 2023; 11:23247096231166672. [PMID: 37032536 PMCID: PMC10101212 DOI: 10.1177/23247096231166672] [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: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.
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Affiliation(s)
- D. Sofia Villacis-Nunez
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Zachary West
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Adil Y. Khan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Fred Rodriguez
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Andi L. Shane
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Heather Rytting
- Department of Pathology, Children’s
Healthcare of Atlanta, Atlanta, GA, USA
| | - Subhadra Shashidharan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Congenital Cardiac
Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S. Clifton
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Surgery, Emory University
School of Medicine, Atlanta, GA, USA
| | - Gary Woods
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Pediatrics, Emory
University School of Medicine, Atlanta, GA, USA
| | - Martha Clabby
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Sampath Prahalad
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Human Genetics, Emory
University School of Medicine, Atlanta, GA, USA
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Alterations in right ventricular mechanics in patients with Behcet’s disease. Int J Cardiovasc Imaging 2022; 38:2333-2343. [DOI: 10.1007/s10554-022-02664-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
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Tharwat S, ElAdle SS, Moshrif AH, Ismail F, El-Shereef R, Talaat EA, Hassanein S, Hisham Y, Gheita TA. Computed tomography pulmonary angiography (CTPA) in Behçet's disease patients: a remarkable gender gap and time to refine the treatment strategy. Clin Rheumatol 2021; 41:195-201. [PMID: 34767109 DOI: 10.1007/s10067-021-05991-2] [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: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the work was to delineate the computed tomography pulmonary angiography (CTPA) findings in Behçet's disease (BD) patients with and without chest manifestations. PATIENTS AND METHODS The study included 122 BD adults recruited from 5 Teaching University Hospitals in Egypt of those who agreed to perform a CTPA. The Arabic version of BD current activity form (BDCAF) and BD damage index (BDI) were assessed. Detailed pulmonary manifestations, examination, plain radiology chest, and CTPA findings were recorded. RESULTS The mean age of patients was 36.9 ± 11.3 years, male:female was 1.8:1, disease duration 9.6 ± 8.2 years, and age at onset 28.3 ± 8.6 years. Their mean BDCAF was 4.4 ± 2.2 and BDI 3.4 ± 1.8. There were chest manifestations in 51 (41.8%) and plain chest x-ray findings in 13 (10.7%) and CTPA findings in 31 (25.4%) in the form of pulmonary thromboembolism in 15 (12.3%), pulmonary aneurysms in 7 (5.7%), pneumonia in 5 (4.1%), interstitial lung disease in 4 (3.3%) and pleural effusion in 3 (2.5%). Patients with chest manifestations had significantly higher frequency of cardiac manifestations (15.7%) compared to those without (2.8%; p = 0.023); chest x-ray findings tended to be higher (17.6% vs 5.6%; p = 0.05) while CTPA findings were significantly detected (51% vs 7%; p < 0.0001). Higher frequency of CTPA findings were in females (p < 0.0001). Yet the rate of serious pulmonary embolisms, aneurysms, and thrombosis was exclusive in males. CONCLUSION Meticulous investigation of the chest manifestations is warranted in BD patients to undermine the actual magnitude of pulmonary impact. CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases. Key Points • Meticulous chest assessment is warranted in Behçet's disease patients to undermine the actual magnitude of pulmonary impact • CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases.
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Affiliation(s)
- Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Suzan S ElAdle
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdel Hafeez Moshrif
- Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Faten Ismail
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Rawhya El-Shereef
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Esraa A Talaat
- Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Sara Hassanein
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Yousra Hisham
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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10
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Attia DHS. Behçet's disease phenotypes and clinical outcomes: A cohort study in egyptian patients. REUMATOLOGIA CLINICA 2021; 17:514-520. [PMID: 34756312 DOI: 10.1016/j.reumae.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/02/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic inflammatory disease with various presentations. The data on the course of BD in Egyptian patients are limited. OBJECTIVES The objective of the study was to describe the evolution and association of the different phenotypes of BD. MATERIAL AND METHODS This chronological cohort study included adult Egyptian patients suffering from BD. Demographic data and the chronological order of the disease's manifestations were collected. RESULTS The study included 233 patients. Their mean age at the onset of the disease was 26.3±6.9 years. The mean duration from onset of the disease to meeting the criteria was 11.2±30.3 months. The mean duration of the disease was 96.8±72.2 months. On onset of the disease, the most common phenotypes were mucocutaneous (84.5%), musculoskeletal (15.9%), ocular (14.6%) and peripheral venous disease (PVD) (7.3%); on the other hand, pulmonary, peripheral arterial and great vessel phenotypes evolved several years after onset of the disease. The mean time from meeting the criteria to the evolution of a new phenotype was 53.8±58.7 months. Associations between the different phenotypes were observed: PVD and superficial thrombophlebitis, peripheral arterial disease and PVD; another association was also observed between aortic involvement and cerebrovascular disease. CONCLUSION BD could continue to evolve several years after onset of the disease, making the previous belief about BD yield questionable. BD tends to respect the anatomy of the affected system. Some phenotypes tend to coexist, suggesting a shared aethiopathogeny and that the disease is of a systemic nature.
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Affiliation(s)
- Doaa H S Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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11
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Alpsoy E, Bozca BC, Bilgic A. Behçet Disease: An Update for Dermatologists. Am J Clin Dermatol 2021; 22:477-502. [PMID: 34061323 DOI: 10.1007/s40257-021-00609-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Behçet disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology with the clinical features of oral and genital ulcers, cutaneous vasculitic lesions, ocular, articular, vascular, gastrointestinal, neurologic, urogenital and cardiac involvement. BD usually appears around the third or fourth decade of life. Gender distribution is roughly equal. The disease is much more frequent in populations along the ancient 'Silk Road', extending from Eastern Asia to countries in the Middle East and the Mediterranean, compared with Western countries, but has universal distribution. Mucocutaneous manifestations are the clinical hallmarks of BD. The diagnostic criteria widely used in the disease's diagnosis are based on mucocutaneous manifestations because of their high sensitivity and/or specificity. Genetic factors are the key driver of BD pathogenesis, and HLA-B51 antigen is the strongest genetic susceptibility factor. Streptococcus sanguinis (S. sanguinis) or microbiome change can trigger innate immune system-mediated inflammation sustained by adaptive immune responses. Epistatic interaction between HLA-B51 and endoplasmic reticulum aminopeptidase 1 (ERAP1) in antigen-presenting cells disrupt T-cell homeostasis leading to downregulation of Tregs and expansion of Th1 and Th17. Thus, neutrophil activation and intense neutrophil infiltration of the affected organs develop in the early stage of inflammation. BD has a variable clinical course with unpredictable exacerbations and remissions. The disease is associated with a high mortality rate, especially in young male patients, and large-vessel, neurological, gastrointestinal system and cardiac involvement are the most important causes of death. The principal aim of treatment should be to prevent irreversible organ damage, especially during the disease's early, active phase. A better understanding of the disease's pathogenesis has provided important information on its management. New drugs, especially apremilast and anti-TNF-α agents are effective in the management of BD and have the potential to improve patients' quality of life, prognosis and survival.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey.
| | - Burcin Cansu Bozca
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
| | - Asli Bilgic
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
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Hammami AS, Jellazi M, Arfa S, Daada S, Ben Hamda K, Achour A, Ouali S. Getting to the <em>heart</em> of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series. Reumatismo 2021; 73:32-43. [PMID: 33874645 DOI: 10.4081/reumatismo.2021.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.
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Affiliation(s)
- A S Hammami
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
| | - M Jellazi
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Arfa
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Daada
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - K Ben Hamda
- Department of Cardiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - A Achour
- Department of Radiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Ouali
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
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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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Ben-David Y, Gur M, Ilivitzki A, Khoury A, Bentur L, Butbul Aviel Y. Atypical cardiopulmonary manifestations in pediatric Behçet's disease. Pediatr Pulmonol 2020; 55:3407-3413. [PMID: 32915509 DOI: 10.1002/ppul.25068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Behçet's disease (BD) is a multisystem autoinflammatory disease of unknown etiology. Cardiopulmonary involvement is rare, especially in young patients, and carries high morbidity and mortality rates. AIM Of 26 patients with pediatric BD enlisted in our center, we encountered three patients with severe atypical cardiorespiratory presentations. Our aim was to describe the manifestations and the course that led to the diagnosis of BD. RESULTS Three adolescents presented with intracardiac thrombi and left anterior descending obstruction causing myocardial infarction, pulmonary artery aneurysm with pulmonary embolism in situ, and suspected epiglottitis. Two patients had a delayed diagnosis of BD, and all had a good response to anti-inflammatory agents. CONCLUSIONS This study demonstrated that pediatric BD is associated with atypical cardiopulmonary manifestations which maybe life threatening. Since diagnosis maybe challenging, a high index of suspicion is needed especially in young patients, to promptly diagnose and treat these complications. Cardiopulmonary signs and symptoms, though uncommon, maybe the first manifestation and a clue to the diagnosis of this rare disease.
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Affiliation(s)
- Yael Ben-David
- Pediatric Pulmonary Unit and CF center, Rappaport Children's Hospital, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Unit and CF center, Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Anat Ilivitzki
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Asaad Khoury
- Pediatric Cardiology Unit, Ruth Rappaport Children's Hospital, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Unit and CF center, Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yonatan Butbul Aviel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Rheumatology Unit, Ruth Rappaport Children's Hospital, Haifa, Israel
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Zhang T, Wu X, Wu Z. A right ventricular mass in a young man with Behçet's disease: A case report. J Card Surg 2020; 35:3620-3622. [PMID: 32985727 DOI: 10.1111/jocs.15073] [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: 08/22/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/05/2023]
Abstract
Behçet's disease (BD) is a rarely seen immune disease with multiple systems involvements. Among them, a cardiac manifestation is a severe and rare complication of BD. Here we reported a young man with BD, complicated with a right ventricular thrombus. Surgery was performed successfully to remove the intracardiac thrombus, and a 2-year follow-up failed to find any new symptoms and pathological findings. Our experience provided a better example for diagnosing and early surgical treatment for intracardiac thrombus of BD.
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Affiliation(s)
- Tailong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelin Wu
- Operating Room, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Qin X, Liang W, Wu Z. A rare case of cardiac mass complicated with chronic thromboembolic pulmonary hypertension. J Card Surg 2020; 35:3567-3568. [PMID: 32939862 DOI: 10.1111/jocs.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaoli Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Attia DHS. Behçet's Disease Phenotypes and Clinical Outcomes: A Cohort Study in Egyptian Patients. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30084-X. [PMID: 32690441 DOI: 10.1016/j.reuma.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/02/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic inflammatory disease with various presentations. The data on the course of BD in Egyptian patients are limited. OBJECTIVES The objective of the study was to describe the evolution and association of the different phenotypes of BD. MATERIAL AND METHODS This chronological cohort study included adult Egyptian patients suffering from BD. Demographic data and the chronological order of the disease's manifestations were collected. RESULTS The study included 233 patients. Their mean age at the onset of the disease was 26.3±6.9 years. The mean duration from onset of the disease to meeting the criteria was 11.2±30.3 months. The mean duration of the disease was 96.8±72.2 months. On onset of the disease, the most common phenotypes were mucocutaneous (84.5%), musculoskeletal (15.9%), ocular (14.6%) and peripheral venous disease (PVD) (7.3%); on the other hand, pulmonary, peripheral arterial and great vessel phenotypes evolved several years after onset of the disease. The mean time from meeting the criteria to the evolution of a new phenotype was 53.8±58.7 months. Associations between the different phenotypes were observed: PVD and superficial thrombophlebitis, peripheral arterial disease and PVD; another association was also observed between aortic involvement and cerebrovascular disease. CONCLUSION BD could continue to evolve several years after onset of the disease, making the previous belief about BD yield questionable. BD tends to respect the anatomy of the affected system. Some phenotypes tend to coexist, suggesting a shared aethiopathogeny and that the disease is of a systemic nature.
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Affiliation(s)
- Doaa H S Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Amchich Y, Reguig N, Boucaid A, Belghoule R, Zegmout A, Bourkadi JE. Intracardiac thrombus in Behçet's disease: a rare case in Morocco. Pan Afr Med J 2020; 36:92. [PMID: 32774651 PMCID: PMC7392863 DOI: 10.11604/pamj.2020.36.92.23741] [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] [Received: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
Behçet’s syndrome is a systemic inflammatory disease generally presented with the triad of uveitis, oral and genital ulcers. However, it may present with gastrointestinal, central nervous system, skin and vascular disease manifestations. Intracardiac thrombus is a rare but serious complication of Behçet’s disease. A 16-year-old man with Behçet’s syndrome was hospitalized into our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic echocardiography and chest scan revealed a right ventricular thrombus. After one month of treatment with cyclophosphamide, and corticosteroid the intracardiac thrombus has been resolved.
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Affiliation(s)
- Younes Amchich
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Nezha Reguig
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | | | - Reda Belghoule
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | - Adil Zegmout
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
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El-Ghobashy N, El-Garf K, Abdo M. Arterial aneurysms in Behçet’s disease patients: Frequency, clinical characteristics and long-term outcome. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Demir S, Sag E, Kaya Akca U, Hazirolan T, Bilginer Y, Ozen S. The Challenge of Treating Pulmonary Vasculitis in Behçet Disease: Two Pediatric Cases. Pediatrics 2019; 144:peds.2019-0162. [PMID: 31320468 DOI: 10.1542/peds.2019-0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 11/24/2022] Open
Abstract
Behçet disease (BD) is a multisystemic autoinflammatory disorder characterized by recurrent mucocutaneous, ocular, musculoskeletal, gastrointestinal, central nervous system, and vascular manifestations. Pulmonary arterial involvement (PAI) of BD is probably the most severe form of vasculitis, at least in children. PAI has a high mortality, morbidity, and recurrence rate. There are limited data regarding treatment and outcomes of pediatric patients with BD with PAI. Herein, we report 2 pediatric patients with BD presented with hemoptysis and support our data with a systematic review. These patients were given immunosuppressive therapy, which covered pulse methylprednisolone followed by oral prednisolone, intravenous cyclophosphamide every 3 weeks for a total of 6 cycles, and interferon-α2a concomitantly. These are the first reported cases in the literature successfully treated with this treatment modality in a complication with 50% mortality. These patients have been followed up for a period of at least 4 years without any vascular recurrence. Pediatricians should be aware that patients with BD may not present with full diagnostic criteria. They should consider BD in a child with PAI to avoid diagnostic delay and start life-saving accurate immunosuppressive treatment.
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Affiliation(s)
- Selcan Demir
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Erdal Sag
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Ummusen Kaya Akca
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Tuncay Hazirolan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey; and
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El Euch M, Bouaziz R, Jaziri F, Fraj E, Kefi A, Abdelghani KB, Turki S, Mahfoudhi M, Abdallah TB. Prolonged fever and intra-cardiac thrombosis revealing Behçet's disease. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:295-298. [PMID: 31213303 DOI: 10.1016/j.jdmv.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prolonged fever (PF) is a challenging problem for physicians since it can be the first manifestation of a large variety of pathologies. Exceptionally, intra-cardiac thrombus (ICT) could explain PF and reveal Behçet's disease (BD). We are reporting a 45-year-old man with BD who has these unusual manifestations. CASE REPORT A 45-year-old man presented with PF and inflammatory biological syndrome during a few months. Echocardiography showed an inhomogeneous and mobile mass in the left auricle. During his hospitalization, the patient had multiple oral aphtosis. The angioscanner showed a sacciform aneurysm of the coeliac trunk. The diagnosis of BD was retained and he was treated with high doses of steroids and cyclophosphamide with a favorable follow-up. CONCLUSION The search for BD should be systematic in view of any suggestive manifestation of severe cardiovascular complications like ICT especially in a young adult man from a high endemicity region.
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Affiliation(s)
- Mounira El Euch
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia.
| | - Rahma Bouaziz
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Fatima Jaziri
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Eya Fraj
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Asma Kefi
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Khaoula Ben Abdelghani
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Sami Turki
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Madiha Mahfoudhi
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Internal medicine department A, University of Tunis Manar, Charles-Nicolle hospital, Tunis, Tunisia
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Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:197-203. [PMID: 28407841 DOI: 10.3238/arztebl.2017.0197] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 05/03/2016] [Accepted: 01/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 1.5 million adults in Germany suffer from an inflammatory rheumatological condition. The most common among these are rheumatoid arthritis and spondyloarthritis-above all axial spondyloarthritis, including ankylosing spondylitis (Bekhterev's disease) and psoriatic arthritis. These systemic inflammatory diseases often affect the heart as well. METHODS This review is based on pertinent articles retrieved by a selective literature search, on current European guidelines, and on the authors' clinical experience. RESULTS Rheumatic inflammation of cardiac structures can manifest itself as pericarditis, myocarditis, or endocarditis. The heart valves and the intracardiac conduction system can be affected as well, leading to AV block. Functional sequelae, e.g., congestive heart failure, can arise as a consequence of any inflammatory rheumatic disease. The long-term mortality of rheumatic diseases is elevated predominantly because of the increased risk for cardiovascular comorbidities. The cardiovascular risk profile should therefore be re-evaluated regularly (e.g., at 5-year intervals) in cooperation with the patient's primary care physician. The cardiovascular manifestations of rheumatic disease, such as pericarditis, myocarditis, and vasculitis, are treated initially with high-dose glucocorticoids and then over the long term with maintenance drugs such as methotrexate and azathioprine. Biological agents are sometimes used as well. CONCLUSION In patients with inflammatory rheumatic diseases, the elevated cardiovascular risk should be kept in mind and preventive measures should be initiated early. This subject should be further studied in controlled trials so that the treatment options for patients with cardiac involvement can be evaluated.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne; Rheumazentrum München, Munich; Department of Medicine 3, Universitätsklinikum Erlangen; Department of Rheumatology, Hiller Research Center Rheumatology, University Hospital Düsseldorf; Department of Rheumatology and Clinical Immunology, St. Josef Krankenhaus, Essen University Hospital; Department of Cardiology, Marien-Hospital Herne, University Hospitals of the Ruhr University of Bochum
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Takayama T, Ozawa T, Sanada A, Watanabe T, Ito M, Hirono S, Aizawa Y, Minamino T. Aortic Regurgitation Presenting with Recurrent Detachment of a Prosthetic Valve, as the First Presenting Symptom of Cardiovascular Behçet's Disease. Intern Med 2018; 57:823-827. [PMID: 29225266 PMCID: PMC5891521 DOI: 10.2169/internalmedicine.9603-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 33-year-old man with severe aortic regurgitation underwent initial aortic valve replacement (AVR). During the 2 years after AVR, 3 reoperations for prosthetic valve detachment were required. During hospitalization, he had no typical clinical findings, with the exception of a persistent inflammatory reaction; a pseudo-aneurysm around the Bentall graft developed 27 days after the 4th operation. This unique clinical course suggested the possibility of Behçet's disease. In the 8 years of follow-up after the administration of prednisolone, the pseudo-aneurysm did not become enlarged and the detachment of the prosthetic valve was not observed. We herein present a case of cardiovascular Behçet's disease, with a review of the literature.
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Affiliation(s)
- Tsugumi Takayama
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takuya Ozawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Akiko Sanada
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Tohru Watanabe
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Masahiro Ito
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Satoru Hirono
- Division of Cardiology, Uonuma Kikan Hospital, Japan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Galeano-Valle F, Demelo-Rodriguez P, Álvarez-Sala-Walther L, Pinilla-Llorente B, Echenagusia-Boyra MJ, Rodriguez-Abella H, Del-Toro-Cervera J. Intracardiac thrombosis in Behçet's Disease successfully treated with immunosuppressive agents: A case of vascular pathergy phenomenon. Intractable Rare Dis Res 2018; 7:54-57. [PMID: 29552448 PMCID: PMC5849627 DOI: 10.5582/irdr.2018.01006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Behçet's Disease (BD) is a rare multi-systemic inflammatory disorder classified as a systemic vasculitis of unknown aetiology. Vascular involvement occurs in approximately 5-51.6% cases, affecting venous and arterial vessels. Cardiac involvement is rare in BD (6%). There have been published approximately 93 cases of BD associated with intracardiac thrombosis, with different treatments and courses. We present a case of a 35-year-old spanish male that, after a percutaneous pharmacomechanical thrombectomy with venous stent placement, developed high fever and extensive venous thrombosis despite anticoagulation including intracardiac thrombosis (ICT) in the right ventricle and pulmonary embolism that leaded to the diagnosis of BD. The patient was successfully treated with immunosuppressants, achieving the complete resolution of ICT. We hypotesize that the endovenous procedure could have acted as a trigger for the posterior acute attack of the disease, representing a 'vascular pathergy phenomenon'. Vascular BD has to be suspected in cases of thrombosis recurrence despite correct anticoagulation, and intense immunosuppressive treatment should be considered.
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Affiliation(s)
- Francisco Galeano-Valle
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Address correspondence to: Dr. Francisco Galeano-Valle, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain. E-mail:
| | - Pablo Demelo-Rodriguez
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
| | - Luís Álvarez-Sala-Walther
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Blanca Pinilla-Llorente
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Hugo Rodriguez-Abella
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit. Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Demir S, Sag E, Dedeoglu F, Ozen S. Vasculitis in Systemic Autoinflammatory Diseases. Front Pediatr 2018; 6:377. [PMID: 30560109 PMCID: PMC6287042 DOI: 10.3389/fped.2018.00377] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
Autoinflammatory diseases (AID) are diseases of the innate immune system, characterized by recurrent episodes of localized or systemic inflammation. Vasculitis may accompany AID. The causes of the association of vasculitis with monogenic AID are still debated. Among the monogenic AID, Familial Mediterranean Fever (FMF) is the most common. IgA-related vasculitis (IgAV) and Polyarteritis Nodosa (PAN) involving small and/or medium-sized vessels have an increased frequency among FMF patients. There are also case reports revealing vasculitic features in Cryopyrin-Associated Periodic Fever Syndrome (CAPS), Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), Mevalonate Kinase Deficiency (MKD), also known as Hyper IgD syndrome (HIDS), Deficiency of IL-1 Receptor Antagonist (DIRA) and Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA) patients. Central nervous system vasculitis and vasculopathy have been reported in DIRA and PAPA patients whereas small vessel involvement affecting skin has been reported in CAPS, TRAPS, and MKD patients. Alternatively, vasculitis can also be a leading feature especially in the recently defined monogenic AID (Otulipenia, Deficiency of Adenosine Deaminase 2-DADA2, Haploinsufficiency of A20) and interferonopathies (STING-associated vasculopathy with onset in infancy-SAVI). DADA2 often presents as a PAN-like disease. In otulipenia, patients have painful subcutaneous nodules caused by septal panniculitis with small and medium vessel vasculitis. Haploinsufficiency of A20 (also called Familial Behcet-like Autoinflammatory Syndrome) results in a phenotype very similar to the variable vessel vasculitis of Behcet's disease with recurrent oral-genital ulcers, in addition to, skin rash, uveitis, and polyarthritis. SAVI is an autoinflammatory vasculopathy with increased Interferon (IFN) signature, causing severe skin lesions resulting in ulceration, necrosis, and in some cases, amputation. Behcet's Disease (BD) is a multifactorial polygenic AID characterized by recurrent attacks of oral-genital ulcers, skin lesions, uveitis and a unique vasculitis affecting both arteries and veins of all sizes. Many clinical features overlap with other autoinflammatory diseases and overexpression of proinflammatory cytokines is an important feature of the disease.
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Affiliation(s)
- Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Dedeoglu
- Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, MA, United States
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Imaging manifestations of Behcet's disease: Key considerations and major features. Eur J Radiol 2017; 98:214-225. [PMID: 29196115 DOI: 10.1016/j.ejrad.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/26/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023]
Abstract
Behcet's disease is an autoimmune disease most commonly seen in the Middle East. Although primarily known with painful oral and genital ulcers, it can lead to vasculitis. Therefore, several associated complications such as thrombotic syndromes, aneurysmal arterial disease may arise. In many cases, it might be difficult to make the diagnosis purely based on clinical grounds; however, imaging plays an important role for both diagnosis and assessment of the disease's complications. We provide a comprehensive review of the most notable imaging findings of Behcet's disease.
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Alekberova ZS, Ovcharov PS, Lisitsyna TA, Volkov AV, Popkova TV. [Behçet's disease: Intracardiac thrombosis (a description of two cases and a review of literature)]. TERAPEVT ARKH 2017. [PMID: 28631704 DOI: 10.17116/terarkh201789579-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behçet's disease (BD) is systemic vasculitis of unknown etiology, which is more common in the countries located along the Great Silk Road. The disease is diagnosed if a patient has 4 key diagnostic signs: aphthous stomatitis, genital sores, and eye and skin lesions. Vascular diseases referred to as minor criteria for BD are characterized by the formation of aneurysms and thrombosis, predominantly in the venous bed. In venous disorders, a blood clot can form in any vessel, including caval, cerebral, pulmonary, and other veins. The paper describes two clinical cases of BD with intracardiac thrombosis. In one case, a 24-year-old male patient with a documented diagnosis of BD, echocardiography revealed a left ventricular spontaneous echo contrast phenomenon that disappeared due to immunosuppressive therapy. The other case was a 34-year-old female patient, in whom the diagnosis was based on the international disease criteria: aphthous stomatitis, skin lesions (pseudopustulosis, erythema nodosum), and genital sores. Computed tomographic angiography showed a 3.7×2.2-cm mass (thrombus) in the right atrium. In addition, blood clots were present in the hepatic and inferior vena cava. No abnormalities in the coagulation system were found in both cases.
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Affiliation(s)
- Z S Alekberova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - P S Ovcharov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T A Lisitsyna
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A V Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Cinar M, Yilmaz S, Akay S, Bozlar U, Dinc A. Clinical course of Behcet's disease in a patient with delayed diagnosis and radiological follow-up of the thrombi with computed tomography angiography: a five-year follow-up under immunosuppressive treatment. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:264-269. [PMID: 28535899 DOI: 10.1016/j.rbre.2013.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 08/12/2013] [Indexed: 06/07/2023] Open
Affiliation(s)
- Muhammet Cinar
- Gulhane Military Medical Academy School of Medicine, Division of Rheumatology, Ankara, Turkey.
| | - Sedat Yilmaz
- Gulhane Military Medical Academy School of Medicine, Division of Rheumatology, Ankara, Turkey
| | - Sinan Akay
- Gulhane Military Medical Academy School of Medicine, Department of Radiology, Ankara, Turkey
| | - Ugur Bozlar
- Gulhane Military Medical Academy School of Medicine, Department of Radiology, Ankara, Turkey
| | - Ayhan Dinc
- Gulhane Military Medical Academy School of Medicine, Division of Rheumatology, Ankara, Turkey
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29
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Evolução clínica da doença de Behçet em paciente com atraso do diagnóstico e seguimento radiológico dos trombos com angiotomografia computadorizada: seguimento por 5 anos durante tratamento imunossupressor. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2013.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Gecmen C, Gecmen GG, Kahyaoglu M, Omar B, Izci S, Kalayci A, Karabay CY, Coban S, Candan O, Yanik E, Izgi IA, Barisik NO. Cardiac masses : Experience from a Turkish tertiary center of cardiology. Herz 2016; 42:690-695. [PMID: 27909765 DOI: 10.1007/s00059-016-4508-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac masses comprise a category that includes benign, malignant, and nontumoral mass lesions. The present study aims to share the findings relating to cardiac masses observed at our tertiary cardiology hospital in Turkey. METHODS The records of patients who presented with cardiac masses and underwent surgery at our institute between 2006 and 2015, and whose tissue samples were sent to a pathology laboratory, were retrospectively reviewed in a consecutive manner. RESULTS The study included 228 patients with an average age of 52.5 ± 17.3 years. Of the study's subjects, 95 (41.7%) were male and 133 (58.3%) female. The most commonly observed mass was myxoma in 68 patients (29.8%), of whom 20 (29.4%) were male and 48 (70.6%) female. The second most frequently detected mass was pannus, with 38 cases (16.7%) - 10 (26.3%) in males and 28 (73.7%) in females. The third most common cardiac mass was thrombus (16.2%), with 18 cases of thrombi in men (48.6%) and 19 (51.4%) in women. CONCLUSION The most commonly observed cardiac mass was myxoma and most were localized in the left atrium. The second most frequently detected mass was pannus, which was mostly found on mitral mechanical prosthetic valves. Thrombi were the third most prevalent mass and were commonly localized in the right atrium.
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Affiliation(s)
- C Gecmen
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey.
| | - G G Gecmen
- Department of Pathology, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - M Kahyaoglu
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - B Omar
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - S Izci
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - A Kalayci
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - C Y Karabay
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - S Coban
- Department of Pathology, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - O Candan
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - E Yanik
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - I A Izgi
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846, Kartal, Istanbul, Turkey
| | - N O Barisik
- Department of Pathology, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
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Abstract
Behçet’s disease (BD) is a multi-system inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis, and erythema nodosum. Behçet’s disease runs a chronic course, with unpredictable exacerbations and remissions whose frequency and severity may diminish with time. Behçet’s disease typically arises in young adults, although childhood-onset BD has also been reported. The disease can affect both genders and has a worldwide distribution, although it is more prevalent in countries of the ancient Silk Route. The cause of BD remains unknown, although an autoimmune reaction triggered by an infectious agent in a genetically predisposed individual has been suggested. The treatment of BD is symptomatic and empirical, but generally specific to the clinical features of each patient. The majority of affected individuals do not have life-threatening disease, although mortality can be associated with vascular-thrombotic and neurological disease.
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Affiliation(s)
- L M Al-Otaibi
- Oral Medicine, Division of Maxillofacial Diagnostic, Medical & Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
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32
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Atzeni F, Sarzi-Puttini P, Doria A, Boiardi L, Pipitone N, Salvarani C. Behçet’s disease and cardiovascular involvement. Lupus 2016; 14:723-6. [PMID: 16218475 DOI: 10.1191/0961203305lu2208oa] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Behcet’s disease (BD) is a multisystem disease of unknown etiology characterized by chronic relapsing orogenital ulcers, uveitis and systemic involvement including articular, gastrointestinal, cardiopulmonary, neurological and vascular pathology. The incidence and nature of cardiac involvement are not clearly elucidated. Cardiovascular manifestations have been reported in 7-46% of patients and mortality occurs in up to 20% of those patients with marked vascular involvement. Sporadic cases of endocarditis, myocarditis, pericarditis, acute myocardial infarction, aortic aneurysm, ventricular thrombosis, congestive cardiomyopathy and valvular dysfunction have been reported. This review discusses the general aspects of the pathogenic mechanisms and clinical features cardiovascular involvement in BD, and provides the data of cardiovascular involvement in a cohort of Italian BD patients.
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Affiliation(s)
- F Atzeni
- Rheumatology Unit, L Sacco University Hospital, Milan, Italy
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33
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Hijazi EM, Ibdah RK, Rawashdeh SI, Saadeh AM, Al-Balas HI. Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet's Disease - From Cardiac Surgical Point of View. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:412-6. [PMID: 27311379 PMCID: PMC4917071 DOI: 10.12659/ajcr.897998] [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] [Indexed: 11/13/2022]
Abstract
Patient: Female, 27 Final Diagnosis: Right atrial thrombus compressing the sinoatrial node Symptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizziness Medication: — Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safely Specialty: Surgery
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Affiliation(s)
- Emad Mohamed Hijazi
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Rasheed Khaled Ibdah
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Sukina Ismael Rawashdeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
| | - Abdullah Mahmoud Saadeh
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology,, Irbid, Jordan
| | - Hamzeh Ibrahim Al-Balas
- Division of Cardiac Surgery and Cardiology, Princess Muna AL-Hussein Cardiac Center, King Abdullah University Hospital and Jordan University of Science and Technology, Irbid, Jordan
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34
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Sabzi F, Mirzaei S, Faraji R. Right Ventricular Thrombus and Cerebral Artery Aneurysm in a Patient with Behçet's Disease. Sultan Qaboos Univ Med J 2016; 16:e250-3. [PMID: 27226921 DOI: 10.18295/squmj.2016.16.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/31/2015] [Accepted: 12/31/2015] [Indexed: 11/16/2022] Open
Abstract
We report a 35-year-old woman referred to the Imam Ali Hospital, Kermanshah, Iran, in July 2014 for evaluation of postoperative dyspnoea after neurosurgery performed seven days previously for a ruptured cerebral artery aneurysm. She was known to have Behçet's disease with a history of recurrent oral and genital aphthous ulcers and uveitis. At referral, her symptoms included vertigo, dysarthria, palpitations and chest pain. Transthoracic echocardiography (TTE) revealed a large thrombus in her right ventricle outflow tract and open-heart surgery was performed eight days after the previous surgery to remove the clot. The postoperative period was complicated by transient acute renal failure, which resolved spontaneously. The patient was discharged 13 days after the cardiac surgery on warfarin, prednisolone, azathioprine and cyclophosphamide. Cyclophosphamide and azathioprine were discontinued after three months as the symptoms had completely resolved; however, prednisolone was continued due to recurrent uveitis. A 10-month follow-up TTE scan revealed no thrombus recurrence and treatment with warfarin and prednisolone was continued.
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Affiliation(s)
- Feridoun Sabzi
- Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samaneh Mirzaei
- Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Faraji
- Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
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35
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Behçet's disease: How to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol 2016; 30:279-295. [DOI: 10.1016/j.berh.2016.08.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 11/20/2022]
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36
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Wang H, Guo X, Tian Z, Liu Y, Wang Q, Li M, Zeng X, Fang Q. Intracardiac thrombus in patients with Behcet's disease: clinical correlates, imaging features, and outcome: a retrospective, single-center experience. Clin Rheumatol 2016; 35:2501-7. [PMID: 26753545 DOI: 10.1007/s10067-015-3161-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/17/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023]
Abstract
Intracardiac thrombus (ICT) is a rare but serious complication of Behcet's disease (BD). The study was to report the clinical characteristics, imaging features, treatment, and outcomes of BD patients with ICT in a single tertiary center. A series of 626 BD patients admitted to Peking Union Medical College hospital between April 2003 and April 2013 were reviewed. A total of 12 (1.9 %) BD patients with ICT were included. ICT was presenting manifestation of BD in 5 of the 12 patients (41.7 %) and occurred mostly in men (9/12, 75 %) younger than 40 years. Patients with ICT had more arterial (66.7 vs. 7.3 %, p < 0.001) and venous involvement (75.0 vs. 8.1 %, p < 0.001) compared to those without ICT. Right heart was the most frequent site of ICT (11/12, 91.7 %). Thrombus were hyperechogenic and immobile with a broad-based attachment on echocardiography in most cases (11/12, 91.7 %). Cardiac magnetic resonance (CMR) was performed in four patients. All thrombi showed isointense on T1-weighted image, while all but one were hypointense on T2-weighted image without delayed enhancement. Remission of ICT was associated with therapy of anticoagulant, corticosteroid, and immunosuppressant in most cases (10/12, 83.3 %). There was no death, and relapses of ICT occurred in only one patient after tapering of immunosuppressant during follow-up. A diagnosis of BD should be considered when a young male patient presents with a mass in the right-sided heart accompanied by vascular lesions. Medical therapy especially adequate immunosuppressants might be the first choice for BD patients with ICT.
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Affiliation(s)
- Hui Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China.
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongdan, Beijing, 100730, China
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Eren H, Öcal L, Kalçik M, Efe SÇ, Evlice M, Akçakoyun M. Intracardiac Thrombus in Behçet's Disease. J Cardiovasc Echogr 2016; 26:22-24. [PMID: 28465956 PMCID: PMC5412740 DOI: 10.4103/2211-4122.178472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Behçet's disease (BD) is a chronic multisystem disease that presents with recurrent oral and genital ulceration and recurrent uveitis. The patients are often diagnosed in the range of 20-30 years of age and BD are more common in men.[1] BD has a worldwide distribution, but it is mainly observed in Mediterranean areas and Japan.[2] Involvement of skin, joints, nervous, respiratory, gastrointestinal, and cardiovascular systems is also recognised.[34] Although the vascular lesions are frequently observed in this disease, the cardiac involvement is rare and is associated with the poor prognosis.[5]
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Affiliation(s)
- Hayati Eren
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Macit Kalçik
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mert Evlice
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Akçakoyun
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Behcet's Disease with Intracardiac Thrombus Presenting with Fever of Unknown Etiology. Case Reports Immunol 2015; 2015:149359. [PMID: 26425377 PMCID: PMC4573877 DOI: 10.1155/2015/149359] [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] [Received: 06/30/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022] Open
Abstract
A young male was referred to us for evaluation of fever of unknown origin (FUO). He had history of recurrent painful oral ulcers for one year and moderate to high grade fever, pustulopapular rash, and recurrent genital ulcers for 6 months and hemoptysis for 3 days. He was detected to have intracardiac thrombi and pulmonary arterial thrombosis along with underlying Behcet's disease (BD). Patient responded to high dose prednisolone (1 mg/Kg/day) along with monthly parenteral cyclophosphamide therapy. This case highlights the fact that BD is an important cause for pulmonary artery vasculitis with intracardiac thrombus formation, and such patients can present with FUO.
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39
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Katz OB, Brenner B, Horowitz NA. Thrombosis in vasculitic disorders-clinical manifestations, pathogenesis and management. Thromb Res 2015. [PMID: 26220271 DOI: 10.1016/j.thromres.2015.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inflammation and coagulation are known to affect each other in many ways. Vasculitis represents a group of disorders where blood vessels (small, medium, large or variable) are infiltrated with inflammatory cells. Accumulating evidence in the literature suggests both clinical and physiological association between vasculitis and thrombosis. Vasculitis-associated thrombosis involves arteries and veins, and a tight connection has been reported between the activity of vasculitis and the appearance of thrombosis. Pathophysiology of these relations is complex and not completely understood. While thrombophilic factors are associated with vasculitis, it remains unclear whether a true association with clinical thrombosis is present. Furthermore, several factors leading to hemostasis, endothelial injury and induction of microparticles were described as possibly accounting for thrombosis. Management of thrombosis in vasculitis patients is challenging and should be further assessed in randomized controlled studies. The current review describes clinical manifestations, pathogenesis and management of thrombosis associated with different vasculitides.
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Affiliation(s)
| | - Benjamin Brenner
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
| | - Netanel A Horowitz
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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40
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Lisitsyna T, Alekberova Z, Ovcharov P, Volkov A, Korsakova J, Nasonov E. Left ventricular intracardiac thrombus in a patient with Behçet disease successfully treated with immunosuppressive agents without anticoagulation: a case report and review of the literature. Rheumatol Int 2015; 35:1931-5. [PMID: 26055535 DOI: 10.1007/s00296-015-3306-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/01/2015] [Indexed: 01/29/2023]
Abstract
Behçet disease (BD) is a chronic multisystem disorder with vasculitis underlying its systemic manifestations. Cardiac involvement and particularly left ventricular intracardiac thrombus are rarely diagnosed in the course of BD and are often associated with poor prognosis. The causes of intracardiac thrombi are unknown. It is plausible that specific proinflammatory pathways resulting in the endothelial cell injury and hypercoagulation contribute to the formation of thrombotic masses in the heart. Known thrombophilic factors such as methylenetetrahydrofolate reductase gene mutations, factor V Leiden mutation, proteins S and C, antithrombin III, activated protein C resistance, and antiphospholipid antibodies may contribute to the formation of intracardiac thrombi in BD. We report a case of a 24-year-old male patient with BD presented with left ventricular thrombus. Transthoracic echocardiography allowed to describe and monitor such a rare cardiac manifestation of the disease. A combination of high-dose corticosteroid and azathioprine successfully dissolved intracardiac thrombus within ten days without anticoagulation.
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Affiliation(s)
- Tatiana Lisitsyna
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Zemfira Alekberova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Pavel Ovcharov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
| | - Alexander Volkov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Julia Korsakova
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia
| | - Evgeni Nasonov
- Nasonova Research Institute of Rheumatology, Russian Academy of Sciences, Kashirskoe shosse 34A, 115522, Moscow, Russia.
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Yahalom M, Bloch L, Suleiman K, Rosh B, Turgeman Y. Cardiovascular Involvement in Behçet Disease: Clinical Implications. Int J Angiol 2015; 25:e84-e86. [PMID: 28031663 DOI: 10.1055/s-0035-1551796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Behçet disease (BD) is a multisystem disorder, with vasculitis as its underlying pathological process, in contrast to the classic triad of recurrent oral and genital ulcerations, with uveitis. Vascular involvement in BD includes venous thrombosis, arterial occlusion, and pulmonary artery and aortic aneurysm formation. Cardiac involvement is rare and often obscure. It includes intracardiac thrombi formation, and is associated with a poor prognosis. Our objectives are to describe two cases with BD, complicated with vascular and cardiac involvement, and to raise awareness of these rare complications, the needed routine surveillance, and thus to prevent inappropriate interventions, serious outcomes, and mortality. We present two male patients from the Mediterranean Basin with BD. The first was diagnosed early as a BD patient. The second was diagnosed at the time of cardiovascular (CV) involvement. We recommend that patients who are diagnosed, or even suspected of suffering from BD, especially in endemic areas along the Silk Route pathway, should be followed up routinely for CV involvement, even if rare, obscure, or with a bizarre presentation.
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Affiliation(s)
- Malka Yahalom
- Heart Institute, HaEmek Medical Center, Afula, Israel
| | - Lev Bloch
- Heart Institute, HaEmek Medical Center, Afula, Israel
| | | | - Bar Rosh
- Heart Institute, HaEmek Medical Center, Afula, Israel
| | - Yoav Turgeman
- Heart Institute, HaEmek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Bhandari C, Rathi L, Gupta M, Khatri J. Right ventricular thrombus with pulmonary artery aneurysm in a young male: A rare presentation of Behçet's disease. Lung India 2015; 32:274-7. [PMID: 25983417 PMCID: PMC4429393 DOI: 10.4103/0970-2113.156253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe an adolescent patient presenting with hemoptysis. Detailed clinical work up of the patient showed right ventricular thrombus and bilateral pulmonary artery aneurysms along with the prescribed criteria for the diagnosis of Behcet's disease. Younger age of the patient was another distinctive feature of this case. Six months of therapy with cyclophosphamide and prednisolone resulted in near complete clinicoradiological response.
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Affiliation(s)
- Chand Bhandari
- Department of Chest and TB, SMS Medical College, Jaipur, Rajasthan, India
| | - Lalit Rathi
- Department of Chest and TB, SMS Medical College, Jaipur, Rajasthan, India
| | - Mridul Gupta
- Department of Medicine, RCSM Government Medical College, Kolhapur, Maharashtra, India
| | - Jaikishan Khatri
- Department of Chest and TB, SMS Medical College, Jaipur, Rajasthan, India
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Farouk H, Chilali KE, Said K, Sakr B, Salah H, Mahmoud G, Sorour K. Value of certain echocardiographic findings in the initial suspicion of Behçet's disease. Echocardiography 2015; 31:924-30. [PMID: 25208862 DOI: 10.1111/echo.12601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To describe the echocardiographic findings detected as first manifestations of Behçet's disease (BD) and compare these findings with those detected in established cases of BD receiving regular medical treatment. METHODS Two groups of patients were studied. Group 1 comprised 41 patients with BD on regular medical treatment. Group 2 comprised 5 previously healthy patients who presented to the cardiology department because of cardiac symptoms and were diagnosed in retrospect during hospitalization as BD. Thirty-two age- and sex-matched individuals served as control subjects (control group). All patients and controls underwent complete M-mode, two-dimensional, and Doppler transthoracic echocardiographic examinations. RESULTS Of the 41 treated patients with BD (mean age: 32 ± 8 years, 90% males, mean duration since diagnosis: 14.5 years), only 1 patient was found to have severe aortic regurgitation secondary to aortic root dilation. On the other hand, the 5 previously healthy patients who presented with cardiac symptoms (mean age: 24 ± 6 years, all males) had significant cardiac involvement and evident echocardiographic findings (P < 0.001). Four cases had intracardiac masses: 3 in the right atrium (RA), 1 in the right ventricle (RV), while the last patient had pericardial effusion (PE). All these patients were diagnosed in retrospect as BD. The RA masses disappeared on medical therapy, while the RV mass was surgically excised and proved to be multiple thrombi histopathologically. The patient with PE had recurrent attacks of massive effusion so a pericardial window was performed surgically. CONCLUSION Diagnosis of BD might be initially suspected by the cardiologists based on certain echocardiographic findings, namely the presence of right-sided masses. Diagnosis of BD in such patients has important therapeutic implications and accordingly prognostic value.
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Affiliation(s)
- Heba Farouk
- Cardiovascular Medicine Department, Cairo University Hospital, Cairo, Egypt
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44
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Multiple Thrombi in a Man With Behçet Disease. J Clin Rheumatol 2015; 21:46-8. [DOI: 10.1097/rhu.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Wu X, Li G, Huang X, Wang L, Liu W, Zhao Y, Zheng W. Behçet's disease complicated with thrombosis: a report of 93 Chinese cases. Medicine (Baltimore) 2014; 93:e263. [PMID: 25526452 PMCID: PMC4603137 DOI: 10.1097/md.0000000000000263] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the clinical features of Behçet's disease (BD) complicated with thrombosis. Medical records of patients with BD at Peking Union Medical College Hospital from 1993 to 2013 were reviewed to identify thrombosis. Of the 766 patients with BD, 93 patients (16 female and 77 male) developed thrombosis. The most common thrombosis was extremity vein thrombosis (86.0%), including deep vein thrombosis (n=78) and superficial thrombophlebitis (n=4). The other thrombosis types associated with BD in descending frequency of order were: vena cava thrombosis (30.1%), pulmonary thromboembolism (15.1%), cerebral venous thrombosis (CVT) (12.9%), intracardiac thrombosis (8.6%), Budd-Chiari syndrome (7.5%), and renal vein thrombosis (4.3%), etc. Venous thrombosis is more frequent than arterial thrombosis, and most of patients (94.6%) experienced multiple thrombosis. A male predominance of extremity vein thrombosis and positive pathergy test, and a female predominance of CVT and genital ulcers were noted. All of these patients exhibited active disease during the emergence of thrombotic events. After treating with glucocorticosteroids, immunosuppressants, and/or anticoagulants, the thrombosis resolved in 89 patients. Three patients died from aneurysm rupture, myocardial infarction and Budd-Chiari syndrome, respectively. One patient with septic shock discontinued therapy during follow-up. Thrombosis in BD patients is male predominance, mainly multiple and venous thrombosis is more common. Active disease patients are prone to thrombosis, which suggest the key role of immunosuppressive therapy for the complication.
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Affiliation(s)
- Xiuhua Wu
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, 100730, China (XW, LW, YZ, WZ); Department of Nephrology, Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot, 010020, China (GL); Department of Rheumatology and Hematology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China, 530021 (XH); and MOE Key Laboratory of Protein Science, School of Life Sciences, Tsinghua University, Beijing, 100084, China (WL)
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Aksu T, Tufekcioglu O. Intracardiac thrombus in Behçet’s disease: four new cases and a comprehensive literature review. Rheumatol Int 2014; 35:1269-79. [DOI: 10.1007/s00296-014-3174-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Núñez-Cabarcas E, López-Ruiz N, Ramírez-Rincón A. Diagnostic dilemma: Intracardiac mass in a woman with Behçet's syndrome. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:273-5. [PMID: 25239201 DOI: 10.1016/j.acmx.2014.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/12/2014] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
Intracardiac thrombosis is a rare manifestation of cardiac involvement in Behçet's disease, and it may be mistaken for a heart tumor. In this letter we present the case of a patient diagnosed with Behçet's disease who was incidentally found to have a mass in the right atrium suspicious of a cardiac tumor. Nevertheless, cardiac magnetic resonance showed a cardiac thrombus. Immunosuppressive therapy and anticoagulation were effective for thrombus resolution.
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Affiliation(s)
| | - Nilson López-Ruiz
- Cardiology Division, Hospital Pablo Tobón Uribe, Medellín, Colombia.
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Abidov A, Alpert JS. Importance of Echocardiographic Findings in the Acute Presentation of Behçet's Disease - Diagnostic and Prognostic Considerations. Echocardiography 2014; 31:913-5. [DOI: 10.1111/echo.12659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Aiden Abidov
- Division of Cardiology; Department of Medicine; The University of Arizona College of Medicine; Tucson Arizona
| | - Joseph S. Alpert
- Division of Cardiology; Department of Medicine; The University of Arizona College of Medicine; Tucson Arizona
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49
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Kuno T, Tamura Y, Ono T, Murata M, Kuwana M, Satoh T, Fukuda K. Recurrent right atrial thrombosis due to Behçet disease. Can J Cardiol 2014; 30:1250.e1-3. [PMID: 25174856 DOI: 10.1016/j.cjca.2014.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/18/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022] Open
Abstract
Behçet disease is a rare condition sometimes associated with chronic cardiac inflammation followed by myocardial dysfunction and vascular inflammation. We report a case of recurrent right atrial thrombus due to Behçet disease despite continued anticoagulation therapy. The thrombus disappeared after the initiation of immunosuppressive therapy. To avoid a progression to thrombus or cardiac dysfunction in this recurrent case, the early identification of cardiac involvement of Behçet disease using echocardiography and/or cardiac magnetic resonance imaging might be important. Combined immunosuppressive therapy with prednisone and cyclophosphamide might be needed to treat recurrent thrombosis due to Behçet disease.
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Affiliation(s)
- Toshiki Kuno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Tamura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Tomohiko Ono
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Kuwana
- Department of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Toru Satoh
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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50
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Leibowitz D, Korem M, Livovsky DM, Peleg H, Chajek-Shaul T, Hiller N. Intracardiac mass as initial cardiac manifestation of Behçet's disease: think before you cut. Echocardiography 2014; 31:E243-6. [PMID: 24931010 DOI: 10.1111/echo.12653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Behçet's disease (BD) is a chronic multisystemic inflammatory disorder. Cardiac abnormalities including intracardiac thrombi have been described in up to 16% of cases. The clinical presentation of cardiac complications in BD may include fever, dyspnea, chest pain, hemoptysis, and edema. We present 2 cases of patients who underwent surgical excision of intracardiac masses thought to be intracardiac malignancies. Further pathological and clinical evaluation established intracardiac inflammatory masses due to BD as the final diagnosis. As intracardiac masses may be the presenting manifestation of BD, it is crucial for echocardiographers to consider BD in the differential diagnosis. A careful history and physical exam looking for signs and symptoms of BD is critical before considering surgical excision of unexplained intracardiac masses. If the final diagnosis is BD anti-inflammatory therapy should be considered the basis of treatment.
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Affiliation(s)
- David Leibowitz
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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