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Chandola S, Chopra K, Chawla R, Azad SV, Jana M, Bagri NK. Pediatric Behçet's disease masquerading as pulmonary malignancy. Int J Rheum Dis 2024; 27:e15262. [PMID: 39031015 DOI: 10.1111/1756-185x.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Stuti Chandola
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Karan Chopra
- Department of Pediatrics, AIIMS, New Delhi, India
| | - Rohan Chawla
- Ophthalmology, Dr Rajendra Prasad Centre, AIIMS, New Delhi, India
| | | | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
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Batu ED, Sener S, Cam V, Aktay Ayaz N, Ozen S. Treatment with Biologic Drugs in Pediatric Behçet's Disease: A Comprehensive Analysis of the Published Data. BioDrugs 2023; 37:813-828. [PMID: 37382804 DOI: 10.1007/s40259-023-00613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Behçet's disease (BD) is a variable vessel vasculitis. Biologic drugs are increasingly used in the treatment of BD. We aimed to analyze biologic drug use in the treatment of pediatric BD. METHODS MEDLINE/PubMed and Scopus databases were searched from the inception of these databases until 15 November 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only reports presenting data of pediatric patients with BD (BD diagnosis < 18 years of age) treated with biologic drugs were included. The demographic features, clinical characteristics, and data on treatment were extracted from the included papers. RESULTS We included 87 articles including 187 pediatric patients with BD treated with biologic drugs (215 biologic treatments). Tumor necrosis factor (TNF)-α inhibitors (176 treatments) were the most frequently used biologic drugs followed by interferons (21 treatments). Other reported biologic treatments were anti-interleukin-1 agents (n = 11), tocilizumab (n = 4), daclizumab (n = 2), and rituximab (n = 1). The most common indication for biologic drug use was ocular involvement (93 treatments) followed by multisystem active disease (29 treatments). Monoclonal TNF-α inhibitors, adalimumab and infliximab, were preferred over etanercept in ocular and gastrointestinal BD. The improvement rates with any TNF-α inhibitor, adalimumab, infliximab, etanercept, and interferons were 78.5%, 86.1%, 63.4%, 87.5%, and 70%; respectively. The organ-specific improvement rate with TNF-α inhibitors was 76.7% and 70% for ocular and gastrointestinal system involvement. Adverse events have been reported for TNF-α inhibitors, interferons, and rituximab. Six of these were severe [TNF-α inhibitors (n = 4); interferons (n = 2)]. CONCLUSIONS The presented systematic literature search revealed that TNF-α inhibitors followed by interferons were the most frequently used biologic drugs in pediatric BD. Both group of biologic treatments appeared to be effective and have an acceptable safety profile in pediatric BD. However, controlled studies are required for analyzing indications for biologic treatments in pediatric BD.
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Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Çocuk Romatoloji Bölümü, Kat: 3 Sıhhiye, 06100, Ankara, Turkey.
| | - Seher Sener
- Division of Rheumatology, Department of Pediatrics, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Çocuk Romatoloji Bölümü, Kat: 3 Sıhhiye, 06100, Ankara, Turkey
| | - Veysel Cam
- Division of Rheumatology, Department of Pediatrics, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Çocuk Romatoloji Bölümü, Kat: 3 Sıhhiye, 06100, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Division of Rheumatology, Department of Pediatrics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Çocuk Romatoloji Bölümü, Kat: 3 Sıhhiye, 06100, Ankara, Turkey
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Akbay Ş, Ekici F, Çomak E. A rare complication of Behçet's disease in a 12-year-old girl: a large intracardiac thrombosis. Cardiol Young 2022; 33:1-3. [PMID: 36377415 DOI: 10.1017/s1047951122003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behcet's disease is a multi-systemic inflammatory disease with a clinical spectrum as a triple complex of recurrent oral, genital ulcers, and uveitis. Cardiac involvement in patients with Behcet's disease is extremely rare and often associated with poor prognosis. Behcet's disease should be considered in the differential diagnosis of right ventricular mass especially in young adults, even there is no typical clinical features of Behcet's disease. In this case, a 12-year-old girl who admitted with chest pain and haemoptysis and then was diagnosed with intracardiac thrombus related to Behcet's disease during follow-up was described.
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Affiliation(s)
- Şenay Akbay
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Filiz Ekici
- Pediatric Cardiology, Akdeniz University Medical School, Antalya, Turkey
| | - Elif Çomak
- Pediatric Rheumatology, Akdeniz University Medical School, Antalya, Turkey
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An unusual case of paediatric Behçet's disease with severe stenosis of the abdominal aorta and recurrent venous thrombi. Cardiol Young 2022; 32:1692-1694. [PMID: 35199635 DOI: 10.1017/s1047951122000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chebbi D, Damak C, Frikha F, Abid W, Rebai M, Snoussi M, Salah RB, Marzouk S, Hentati A, Bahloul Z. Cavitary lung opacity of unusual cause during Behçet disease. Clin Case Rep 2022; 10:e6173. [PMID: 35990381 PMCID: PMC9376141 DOI: 10.1002/ccr3.6173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022] Open
Abstract
Pulmonary artery aneurysm must be evoked in front of any hemoptysis in a patient with Behçet disease as it requires urgent immunosuppressive therapy and often surgery.
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Affiliation(s)
- Donia Chebbi
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Chifa Damak
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Faten Frikha
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Walid Abid
- Department of Thoracic SurgeryHabib Bourguiba University HospitalSfaxTunisia
| | - Mohamed Rebai
- Department of Thoracic SurgeryHabib Bourguiba University HospitalSfaxTunisia
| | - Mouna Snoussi
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Raida Ben Salah
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Sameh Marzouk
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
| | - Abdessalem Hentati
- Department of Thoracic SurgeryHabib Bourguiba University HospitalSfaxTunisia
| | - Zouhir Bahloul
- Department of Internal MedicineHedi Chaker University HospitalSfaxTunisia
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Abstract
Vasculitides are defined according to the vessel size involved, and they tend to affect certain organ systems. Pulmonary involvement is rare in the common childhood vasculitides, such as Kawasaki disease, IgA vasculitis (Henoch Schonlein purpura). On the other hand, lung involvement is common in a rare pediatric vasculitis, granulomatosis with polyangiitis (GPA) (Wegener granulomatosis), where respiratory system findings are common. A criterion in the Ankara 2008 classification criteria for GPA is the presence of nodules, cavities, or fixed infiltrates. The adult data suggest that rituximab may be an alternative to cyclophosphamide in induction treatment.
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Affiliation(s)
- Muserref Kasap Cuceoglu
- Department of Pediatric Rheumatology, Hacettepe University, Sihhiye Campus, Ankara 06100, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Sihhiye Campus, Ankara 06100, Turkey.
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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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Hu YC, Chiang BL, Yang YH. Clinical Manifestations and Management of Pediatric Behçet's Disease. Clin Rev Allergy Immunol 2020; 61:171-180. [PMID: 32767171 DOI: 10.1007/s12016-020-08809-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Behçet's disease (BD) is a chronic, vasculitic disorder affecting all sizes of vessels. The disease rarely onsets at childhood and an early diagnosis is often challenging. Oral ulceration and fever of unknown cause are common initial manifestations that might confuse other inflammatory disorders. The clinical manifestation pattern in pediatric BD is heterogeneous and varies in different genders, ethnicities, and geographic regions. There are also some differences in clinical presentations and prognosis between pediatric and adult BD. The disease also affects children at an extremely young age with mostly benign outcomes compared with that in older children. A limited number of studies reported issues about pediatric BD, let alone studies of children's treatments. Currently, the recommendation of the treatment in pediatric BD is according to the guideline of adult BD. The heterogeneity of clinical features makes the treatment more complicated. The main goal of the treatment is to control the inflammatory process and prevent recurrences. We will discourse the definition, epidemiology, clinical features, diagnosis, and treatment of pediatric BD in this review.
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Affiliation(s)
- Ya-Chiao Hu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Jingguo Road, Hsinchu City, Taiwan. .,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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