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Álvarez Pérez LF, Vila S. Exacerbation of Behcet's Disease and Pyoderma Gangrenosum Following COVID-19 Infection: A Case Report. Cureus 2023; 15:e49386. [PMID: 38146565 PMCID: PMC10749583 DOI: 10.7759/cureus.49386] [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] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Behcet's disease (BD) and pyoderma gangrenosum (PG) are rare autoimmune inflammatory diseases that have been reported to relapse following COVID-19 infection. BD is a multisystemic syndrome that may involve multiple body organs. PG is a skin disease that can be a part of the skin involvement of BD. We report a 33-year-old woman with BD and PG who developed headaches, arthralgias, and rapidly progressive painful skin ulcers after COVID-19. She had not complained about BD or PG symptoms for two years prior to admission. Treatment at admission comprised infliximab 560 mg every eight weeks, azathioprine 50 mg daily, and low-dose aspirin. Due to the suspicion of neuro BD and the rapid appearance and progression of the ulcers, she was treated with intravenous (IV) methylprednisolone 1000 mg daily three times followed by prednisone at 1 mg/kg/day. Azathioprine was increased to 100 mg bid. Local ulcer care was provided. She was discharged home on the eighth hospital day. The arthralgias were completely gone, and the headaches and skin ulcers had improved. Six months after discharge, she was off prednisone and continued infliximab and azathioprine. She had no headaches or joint pains, and the ulcers had completely healed. One year after admission, BD and PG signs and symptoms had completely disappeared. This case highlights the importance of recognizing that autoimmune diseases may exacerbate COVID-19. Timely management is crucial to prevent complications and morbidity. To our knowledge, this is a rare case report describing BD and PG exacerbation following COVID-19.
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Affiliation(s)
- Luis F Álvarez Pérez
- Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Salvador Vila
- Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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Bugaut H, Barete S, Bagot M, Bouaziz JD, Le Pelletier de Glatigny F, Gallien Y, Biard L, Domont F, Cacoub P, Saadoun D, Comarmond C. Neutrophilic dermatosis and hidradenitis suppurativa in patients with Behçet's disease: A neutrophilic disease in the spectrum of autoinflammatory syndromes. Semin Arthritis Rheum 2023; 61:152224. [PMID: 37207416 DOI: 10.1016/j.semarthrit.2023.152224] [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: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Association of neutrophilic dermatosis (ND), hidradenitis suppurativa (HS) and Behçet's disease (BD) and shared efficacy of TNFα axis blockade suggests common physiopathology. OBJECTIVES To investigate the clinical features and therapeutic response of ND and HS associated with BD. METHODS We identified 20 patients with ND or HS associated with BD among 1462 patients with BD. RESULTS We analysed 20 (1.4%) patients diagnosed with ND or HS associated with BD: 13 HS, 6 pyoderma gangrenosum (PG), and 1 SAPHO. Our 6 PG cases over 1462 BD patients accounts for 400/100 000 prevalence. Thirteen had bipolar aphthosis, 6 vascular, 5 neurologic, and 4 ocular involvements. All PG occurred on limbs and had typical histology with constant dermal neutrophilic infiltrate. All HS had the classical axillary-mammary phenotype. Sixty-nine percent (69%) of HS were Hurley 1 stage. Treatment consisted mainly in colchicine (n = 20), glucocorticoids (n = 12), and anti-TNFα (n = 9). Interesting results with complete or partial responses were obtained with anti-TNFα (9 cases), ustekinumab (3 cases) and tocilizumab (1 case) to treat refractory ND or HS associated with BD. CONCLUSION PG seems overrepresented in patients with BD. Biotherapies such as anti-TNFα, ustekinumab and tocilizumab appear to be promising to treat refractory ND or HS associated with BD.
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Affiliation(s)
- Hélène Bugaut
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Stéphane Barete
- Unit of Dermatology, Pitié-Salpêtrière Hospital, APHP, DMU3ID, Sorbonne Université, Paris 75013, France
| | - Martine Bagot
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Jean-David Bouaziz
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | | | - Yves Gallien
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Lucie Biard
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France.
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris 75010, France
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Chicha H, Taharboucht S, Tiboune N, Touati N, Chibane A. Genital pyoderma gangrenosum revealing Behçet’s disease: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pyoderma gangrenosum (PG) is a rare and chronic neutrophilic dermatosis. It is clinically characterized by aseptic ulcerations preferentially located in the lower limbs. Its location in the genital area is unusual and could be a source of diagnostic difficulties. In half of the cases, PG is associated with an underlying disease. The association with Behçet’s disease is exceptional.
Case presentation
We report an original observation of a patient who presented a vulvar PG which revealed a Behçet’s disease.
Conclusion
The distinction between these two pathologies was difficult because of the similarity of the cutaneous-mucous lesions on the one hand, and the absence of histological specificity of these two pathologies on the other hand.
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Kashiwado Y, Uchino A, Ota T, Nagano S. Intestinal Behçet's disease with pyoderma gangrenosum successfully treated with the combination therapy of adalimumab and glucocorticoids. Mod Rheumatol 2016; 28:901-905. [PMID: 27142127 DOI: 10.3109/14397595.2016.1174327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 24-year-old male presented with orogenital ulcers, folliculitis, and progressive painful skin ulcers with a raised inflammatory border. Colonoscopy revealed volcano-shaped intestinal ulcers in the ascending colon, and hence, he was diagnosed as intestinal Behçets disease (BD) with pyoderma gangrenosum (PG). Treatment with systemic glucocorticoids and adalimumab dramatically improved the patient's symptoms. Our case demonstrates that early induction of adalimumab may contribute to the successful treatment of such difficult-to-treat conditions as intestinal BD with PG.
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Affiliation(s)
- Yusuke Kashiwado
- a Department of Rheumatology , Aso Iizuka Hospital , Fukuoka , Japan
| | - Ayumi Uchino
- a Department of Rheumatology , Aso Iizuka Hospital , Fukuoka , Japan
| | - Toshiyuki Ota
- a Department of Rheumatology , Aso Iizuka Hospital , Fukuoka , Japan
| | - Shuji Nagano
- a Department of Rheumatology , Aso Iizuka Hospital , Fukuoka , Japan
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Linck V, Sanchez B, Baubion E, Molinie V, Deligny C, Quist D, Derancourt C. [Pyoderma gangrenosum and neutrophilic aortitis preceding the development of rheumatoid arthritis]. Ann Dermatol Venereol 2015; 142:425-9. [PMID: 25863922 DOI: 10.1016/j.annder.2015.02.022] [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] [Received: 09/15/2014] [Revised: 11/28/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We report a case of pyoderma gangrenosum (PG) associated with a complication comprising ascending aortic dissection (neutrophilic aortitis) in a setting of rheumatoid arthritis (RA). PATIENTS AND METHODS A 79-year-old female patient was hospitalized in late 2009 for vegetating PG. Treatment with general steroids followed by colchicine and topical steroids resulted in complete healing of skin lesions. During hospitalization, the patient presented dissection of the ascending part of the aorta, for which emergency surgery proved effective. Histological examination of the excised tissue revealed diffuse neutrophilic aortitis. Diagnoses of Takayashu's disease and of lupus were ruled out. A chest CT scan showed interstitial lung disease with mild lymphocytosis in the bronchoalveolar fluid, but with no isolated pathogenic organisms. Relapse of skin lesions occurred 3 and 4 years later, associated with the development of RA, and worsening of the interstitial lung disease was noted in a scan carried out it in 2013, following which stabilization was observed in April 2014. There was no recurrence of the PG lesions. CONCLUSION To our knowledge, no other cases involving association of neutrophilic aortitis with PG and RA has been published to date. The literature describes the emergence of the concept of systemic neutrophilic dermatoses, and this notion is reinforced by the presence of a cutaneous and aortic site of the neutrophilic disease in a single patient.
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Affiliation(s)
- V Linck
- Service de dermatologie, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France.
| | - B Sanchez
- Service de chirurgie thoracique, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
| | - E Baubion
- Service de dermatologie, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
| | - V Molinie
- Service d'anatomopathologie, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
| | - C Deligny
- Service de médecine interne, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
| | - D Quist
- Service de dermatologie, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
| | - C Derancourt
- DRCI, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, France
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Ozuguz P, Kacar SD, Manav V, Karaca S, Aktepe F, Ulu S. Genital Ulcerative Pyoderma Gangrenosum in Behçet's Disease: A Case Report and Review of the Literature. Indian J Dermatol 2015; 60:105. [PMID: 25657430 PMCID: PMC4318036 DOI: 10.4103/0019-5154.147866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Behçet's disease (BD), first described by Hulusi Behcet, is a multisystemic disease characterized by recurrent oral and genital ulcerations, ocular and cutaneous lesions, arthritis and vascular disease. Pyoderma gangrenosum (PG) is a rare, chronic, sterile pustular and progressive ulcerative process of unknown cause; sometimes can participate in the differential diagnosis of Behcet's ulceration. A 33-year-old woman complained a severe genital ulcer. She had a purulent oozing and stinky ulceration on the right side of labium minor measuring 5-8 cm. A punch biopsy at ulcer margin showed that the lymphocytic panniculitis was extending to the subcutaneous fat tissue without fibrin deposition or necrotic changes in the vessel wall. Based on the clinical and histological findings, she was diagnosed as genital ulcerative PG, which occurred during the exacerbation of BD.
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Affiliation(s)
- Pinar Ozuguz
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | | | - Vildan Manav
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | - Semsettin Karaca
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | - Fatma Aktepe
- Department of Pathology, Afyon Kocatepe University Dermatology, Afyon, Turkey
| | - Sena Ulu
- Department of Nephrology, Afyon Kocatepe University Dermatology, Afyon, Turkey
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Patier de la Peña JL, Moreno-Cobo MÁ, Sánchez-Conde M, Echaniz Quintana AM. Behçet disease and refractory pyoderma gangrenosum with response to infliximab. Rev Clin Esp 2014; 215:66-7. [PMID: 25439188 DOI: 10.1016/j.rce.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 11/25/2022]
Affiliation(s)
| | - M Á Moreno-Cobo
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Sánchez-Conde
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A M Echaniz Quintana
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
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Grigg EL, Kane S, Katz S. Mimicry and deception in inflammatory bowel disease and intestinal behçet disease. Gastroenterol Hepatol (N Y) 2012; 8:103-112. [PMID: 22485077 PMCID: PMC3317507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Behçet disease (BD) is a rare, chronic, multisystemic, inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Intestinal BD occurs in 10-15% of BD patients and shares many clinical characteristics with inflammatory bowel disease (IBD), making differentiation of the 2 diseases very difficult and occasionally impossible. The diagnosis of intestinal BD is based on clinical findings-as there is no pathognomonic laboratory test-and should be considered in patients who present with abdominal pain, diarrhea, weight loss, and rectal bleeding and who are susceptible to intestinal BD. Treatment for intestinal BD is similar to that for IBD, but overall prognosis is worse for intestinal BD. Although intestinal BD is extremely rare in the United States, physicians will increasingly encounter these challenging patients in the future due to increased immigration rates of Asian and Mediterranean populations.
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Affiliation(s)
- Erika L Grigg
- Dr. Grigg is a Gastroenterology Fellow at Georgia Health Sciences University in Augusta, Georgia. Dr. Kane is a Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. Dr. Katz is a Clinical Professor of Medicine at Albert Einstein College of Medicine in Great Neck, New York
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9
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Hali F, Khadir K, Chiheb S, Bouayad K, Mikou N, Benchikhi H. Pyoderma gangrenosum et maladie de Behçet : étude de 2 observations pédiatriques. Arch Pediatr 2011; 18:1320-3. [DOI: 10.1016/j.arcped.2011.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/01/2011] [Accepted: 09/18/2011] [Indexed: 10/15/2022]
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10
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Postoperative Pyoderma Gangrenosum After Elective Abdominoplasty: A Case Report and Review of the Literature. J Burn Care Res 2010; 31:959-63. [DOI: 10.1097/bcr.0b013e3181f93ab1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Alexoudi I, Kapsimali V, Vaiopoulos A, Kanakis M, Vaiopoulos G. Evaluation of current therapeutic strategies in Behçet's disease. Clin Rheumatol 2010; 30:157-63. [PMID: 20842513 DOI: 10.1007/s10067-010-1566-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 08/30/2010] [Indexed: 11/28/2022]
Abstract
Behçet's disease (BD) is a chronic relapsing vasculitis with multifunctional pathogenesis. The mucocutaneous and ocular lesions are the commonest manifestations, but BD also affects the musculoskeletal, intestinal, cardiac, and central nervous system. BD therapy is based on the suppression of the inflammatory process, using immunomodulating and immunosuppressive agents. In selected cases, invasive procedures may be required.
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Affiliation(s)
- Iliana Alexoudi
- First Department of Internal Medicine, University of Athens, Laikon Hospital, 69 Vosporou Str, Athens, 10444, Greece.
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Hiregoudar AD, Battal MM, Vishwanath N, Nadaf SC, Rao R, Dinesh US. Subtotal colectomy for intestinal Behcet's disease: a histopathological surprise. Indian J Surg 2009; 71:159-61. [PMID: 23133142 PMCID: PMC3452476 DOI: 10.1007/s12262-009-0043-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 08/27/2008] [Indexed: 11/24/2022] Open
Abstract
A 40-year-old male who was diagnosed to be having ileocaecal tuberculosis by colonoscopy elsewhere was put on antitubercular treatment. Despite therapy over three months patient had recurrent bouts of lower abdominal pain and was admitted repeatedly with features of subacute intestinal obstruction. CT- abdomen revealed concentric large bowel thickening at multiple sites with features of stenosing lesions. Patient underwent an exploratory laparotomy and subtotal colectomy was done for the diseased large bowel. Post operative histopathological examination revealed it to be Behcet's disease. We report a rare case of intestinal Behcet's disease requiring subtotal colectomy.
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Affiliation(s)
- Abhijit D. Hiregoudar
- Department of Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
| | - Mukunda M. Battal
- Department of Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
| | - N. Vishwanath
- Department of Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
| | - S. C. Nadaf
- Department of Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
| | - Ravikala Rao
- Department of Pathology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
| | - U. S. Dinesh
- Department of Pathology, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, 580 009 Karnataka India
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Ebert EC. Gastrointestinal manifestations of Behçet's disease. Dig Dis Sci 2009; 54:201-7. [PMID: 18594975 DOI: 10.1007/s10620-008-0337-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Accepted: 05/06/2008] [Indexed: 12/13/2022]
Abstract
Behçet's disease is a rare vasculitis diagnosed by the presence of recurrent oral ulcers and two of the following: genital ulcers, typical eye lesions, typical skin lesions, and positive pathergy test. It is most commonly seen in countries along the ancient silk road from Eastern Asia to the Mediterranean Basin. Young adults between the second and fourth decades of life are mainly affected, with abdominal pain being the most common symptom. The ileocecal region is most commonly affected, with ulcerations that may penetrate or perforate. Rarely, the esophagus and stomach may have ulcerations. Bowel wall thickening is the most common finding on computed tomography (CT) scan. Pathology shows a vasculitis mainly involving the small veins or, alternatively, nonspecific inflammation. Corticosteroids, with or without other immunosuppressive drugs, are used for severe eye disease. Their use in intestinal disease is largely empirical. Surgery may be required for perforation. Behçet's disease runs a chronic, unpredictable course with exacerbations and remissions which decrease in frequency and severity over time. Death is mainly due to major vessel disease and neurological involvement.
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Affiliation(s)
- Ellen C Ebert
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
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Accelerated Healing of Pyoderma Gangrenosum in Behçet Patient Treated With Cyclosporine and Split Thickness Skin Graft. Ann Plast Surg 2008; 61:552-4. [DOI: 10.1097/sap.0b013e31816dd391] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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TSUBOI H. Case of pyoderma gangrenosum showing oral and genital ulcers, misdiagnosed as Behcet's disease at first medical examination. J Dermatol 2008; 35:289-92. [DOI: 10.1111/j.1346-8138.2008.00468.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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