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Abstract
Behçet Disease is a relapsing and remitting variable vessel vasculitis characterized by recurrent mucocutaneous ulcers that can involve almost every organ system in the body. Indeed, the presence of recurrent oral or genital ulcers with other auto-inflammatory symptoms should raise suspicion for this elusive disease. It is unique among the vasculitides in that it can affect vessels of small, medium, and large size and tends to involve venous rather than arterial circulation, and its effects on the pulmonary venous circulation are particularly notable for their role in disease mortality. Classically seen in Mediterranean, Middle-Eastern, and eastern Asian countries, and relatively rare in the United States, prevalence has been increasing, prompting an increased need for internists to be aware of Behcet's clinical presentation and treatment. As early recognition and diagnosis of the disease is key to successful treatment and better prognosis, this review provides a brief summary of the current etiological theories, important clinical manifestations, and treatments including newer biologic alternatives.
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Affiliation(s)
- Daniel Pak
- Internal Medicine, St Mary Medical Center, Langhorne, Pennsylvania, USA
| | - Hyon Ju Park
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:diagnostics12112868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [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: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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Wang HL, Zhang JH, Wu YC, Lin JL, Tang Y, Liao LS, Luo JW, Yu QH, Fang ZT. Case report and analysis: Behçet’s disease with lower extremity vein thrombosis and pseudoaneurysm. Front Immunol 2022; 13:949356. [PMID: 36105822 PMCID: PMC9464869 DOI: 10.3389/fimmu.2022.949356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Behçet’s disease (BD) is a unique autoimmune chronic systemic vasculitis that affects veins and arteries of all sizes. BD can lead to recurrent vascular events, especially venous thrombosis, with an incidence rate of 40%, or pseudoaneurysms formed under long-term inflammatory reaction or iatrogenic stimulation. BD-related risk factors promote endothelial dysfunction, platelet activation and overactivation of tissue factors leading to mural inflammatory thrombi. Thrombosis may be the first clinical manifestation of BD. Case presentation A 32-year-old man complaining of progressive swelling and pain in the right lower extremity for 30 days was initially diagnosed with “venous thrombosis of the right lower extremity,” using color Doppler ultrasonography. Patient underwent inferior vena cava filter placement combined with deep vein angioplasty of the right lower extremity and catheter-directed urokinase thrombolysis. Postoperative oral anticoagulant therapy was administered. However, the patient was readmitted 20 days later for pulsatile pain in the right groin. Prior medical history included 4 years of repeated oral and perineal ulcers, and 2 months of blurred vision. Abdominal computed tomography angiography (CTA) revealed rupture of the right common iliac artery (CIA) and left internal iliac artery (IIA), complicated by a pseudoaneurysm. Based on the clinical manifestations and other auxiliary examination results, the patient was re-diagnosed with “BD combined with deep venous thrombosis of the right lower extremity and an iliac artery pseudoaneurysm.” Stent implantation was performed for iliac artery pseudoaneurysm after symptoms were controlled with timely immunosuppressive therapy. After endovascular treatment, the patient underwent continued immunosuppressive therapy and dynamic reexaminations of abdominal CTA, which revealed that a small amount of contrast agent at the stent in the right CIA continued to flow into the cavity of the pseudoaneurysm; in addition, the size of the pseudoaneurysm was gradually increasing. Therefore, the patient underwent a second stent implantation for iliac artery pseudoaneurysm, and the condition improved further. Conclusion The importance of early diagnosis of BD should be recognized, and the choice of interventional and surgical procedures should be carefully evaluated, as this may trigger further damage to vascular access in BD patients with aneurysm.
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Affiliation(s)
- Han-Lu Wang
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jian-Hui Zhang
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yi-Cheng Wu
- Electrocardiography Department of Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Jia-Li Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Li-Sheng Liao
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jie-Wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- *Correspondence: Jie-Wei Luo, ; Qing-Hua Yu, ; Zhu-Ting Fang,
| | - Qing-Hua Yu
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- *Correspondence: Jie-Wei Luo, ; Qing-Hua Yu, ; Zhu-Ting Fang,
| | - Zhu-Ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Jie-Wei Luo, ; Qing-Hua Yu, ; Zhu-Ting Fang,
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Nassef EM, Elabd HA, El Nagger BMMA, Elzomor HM, Kotb HG, Sabry S, Zaghloul BA, Hassan AS, Mohamed EES. Serum Endocan Levels and Subclinical Atherosclerosis in Behçet's Syndrome. Int J Gen Med 2022; 15:6653-6659. [PMID: 36003085 PMCID: PMC9394648 DOI: 10.2147/ijgm.s373863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aim Behçet disease (BD) is a rare chronic relapsing-remitting inflammatory systemic vasculitis. BD patients were reported to have marked acceleration of subclinical atherosclerosis (SCA). Endocan is a soluble proteoglycan mainly secreted by the activated endothelium. The present study aimed to assess the relation between serum endocan levels and SCA in BD patients. Subjects and Methods The study included 40 adult BD patients in addition to twenty age- and sex-matched healthy controls. BD was diagnosed according to International Study Group criteria. Upon recruitment, all participants were subjected to careful history taking and thorough clinical examination. BD activity was assessed using Behçet Syndrome Activity Score. Measurement of serum endocan was performed using quantitative double-antibody sandwich ELISA kit. CIMT measurement was done using B-mode ultrasound. Results Comparison between patients and controls regarding serum endocan levels revealed significantly higher endocan levels in BD patients [median (IQR): 155.0 (69.3–610.0) versus 73.8 (51.9–94.6)]. Using ultrasound assessment, SCA was found in 14 BD patients (35.0%). Comparison between patients with SCA and patients without regarding the clinical and laboratory data revealed that the former group had significantly higher CRP [median (IQR): 36.5 (26.8–43.5) versus 21.0 (11.8–26.8) mg/dL, p < 0.001] and endocan [median (IQR): 622.0 (107.4–974.8) versus 104.5 (64.0–342.0) mg/dL, p = 0.004] levels. Logistic regression analysis recognized endocan [OR (95% CI): 1.0 (1.0–1.012), p0.035] levels as significant predictor of SCA in multivariate analysis. Conclusion The present study identified the clinical value of serum endocan levels as a possible early marker of vascular involvement in BD patients.
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Affiliation(s)
- Eman Mostafa Nassef
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hemmat Ahmed Elabd
- Rheumatology and Rehabilitation Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Hala Mohamed Elzomor
- Rheumatology and Rehabilitation Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hend Gamal Kotb
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Seham Sabry
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Boshra Ahmed Zaghloul
- Radiodiagnosis Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Asmaa S Hassan
- Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman El Sayed Mohamed
- Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Fan S, Shi X, Chen Z, Li X, Yu S, Li J. Retinal and choroidal microvascular alterations in Behcet’s disease without ocular manifestations: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:911990. [PMID: 35935767 PMCID: PMC9353174 DOI: 10.3389/fmed.2022.911990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 12/12/2022] Open
Abstract
PurposeWe performed a systematic review and meta-analysis to examine the microvascular alterations in non-ocular Behcet’s disease (BD) using optical coherence tomography angiography (OCTA).MethodsA comprehensive search was performed in Pubmed, Embase and Cochrane databases for eligible studies from inception to February 2022. Detailed clinical demographics were extracted from each study by two independent reviewers. The weighted mean difference (WMD) and 95% confidence intervals (CI) were used to compare the OCTA parameters between non-ocular BD and healthy controls. Stata 12.0 was adopted to conduct statistical analyses.ResultsTen cross-sectional studies involving 386 eyes in non-ocular BD and 418 eyes in healthy volunteers were ultimately included in the present analysis. When considering superficial capillary plexus (SCP) and deep capillary plexus (DCP), no significant differences of vessel densities in the whole enface image, fovea and perifovea were evaluated between two groups. Significantly reduced parafoveal vessel density of SCP was observed in non-ocular BD in comparison with healthy group (WMD = −1.33, 95%CI: −1.78, −0.89; I2 = 0.6%), while slightly decreased parafoveal vessel density was assessed in DCP (WMD = −1.47, 95%CI: −3.30, 0.35; I2 = 89.3%). Significantly increasing foveal avascular zone (FAZ) area was observed in non-ocular BD when compared to healthy controls (WMD = 0.11, 95%CI: 0.03, 0.19; I2 = 95.3%). There was no significant difference in flow area of choriocapillaris between non-ocular BD and control group (WMD = 0.06, 95%CI: −0.19, 0.32; I2 = 0%).ConclusionBased on current analysis, our results demonstrated significantly lower parafoveal vessel density of SCP and lager FAZ area in full vasculature in non-ocular BD. The retinal microvascular alterations appear before the emergence of ocular manifestations.Systematic Trial Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021244856].
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Affiliation(s)
- Shipei Fan
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xingyu Shi
- Department of Nephrology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Zhen Chen
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xia Li
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Songping Yu
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- *Correspondence: Songping Yu,
| | - Jun Li
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Jun Li,
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Radial artery aneurysm revealing paediatric Behçet's disease: a rare finding. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ruptured abdominal aortic aneurysm reveals Behçet's disease. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ageno W. Difficult challenges in vascular medicine. Minerva Med 2021; 112:698-700. [PMID: 34236159 DOI: 10.23736/s0026-4806.21.07702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy -
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