Choi Joon Young, Kim Sung-Hwan, Kwok Seung-Ki, Jung Jung Im, Lee Kyo-Young, Kim Tae-Jung, Kang Ji Young
Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea.
Department of Radiology, College of Medicine, the Catholic University of Korea, Seoul, Korea.
J Thorac Dis. 2016 Jul;8(7):E547-51. doi: 10.21037/jtd.2016.05.88.
Behçet's disease is a systemic disease which may involve various organs. We describe a case of a patient diagnosed as pleuropericardial involvement of Behçet's disease. A 30-year-old woman visited our clinic presented with left pleuritic chest pain for s days. She had been diagnosed as Behçet's disease and admitted to our clinic due to pericardial and pleural effusion repeatedly in past two years. In the previous studies, effusion analysis revealed to be lympho-dominant exudate with high adenosine deaminase level. Acid-fast bacilli (AFB) culture and polymerase chain reaction (PCR) for mycobacterial tuberculosis (M.TB) were negative in the pericardial tissue, and pathologic finding showed mild endothelitis with micro-thrombi formation in the lumen. The patient had been treated with antituberculous medication for a year. In the current admission, chest computed tomography (CT) again showed left pleural effusion without other significant lesion. Pleural fluid analysis was similar with the previous study. Video-assisted thoracoscopic pleural biopsy was performed to obtain the definite diagnosis. Pathology confirmed the diagnosis as pleuropericardial involvement of Behçet's disease, and we treated the patient with oral steroid in the out-patient department. Pleuropericardial involvement of Behçet's disease may mimic TB pleurisy or pericarditis due to high adenosine deaminase (ADA) level in effusion analysis. Clinicians should keep in mind that Behçet's disease may manifest as pleural or pericardial effusion, and pathologic confirmation could be helpful for the definite diagnosis.
白塞病是一种可累及多个器官的全身性疾病。我们描述了一例被诊断为白塞病胸膜心包受累的患者。一名30岁女性因左侧胸膜炎性胸痛5天前来我院就诊。她曾被诊断为白塞病，在过去两年中因心包和胸腔积液反复入住我院。在之前的研究中，积液分析显示为以淋巴细胞为主的渗出液，腺苷脱氨酶水平较高。心包组织中结核分枝杆菌（M.TB）的抗酸杆菌（AFB）培养和聚合酶链反应（PCR）均为阴性，病理检查显示轻度内皮炎症，管腔内有微血栓形成。该患者接受了一年的抗结核药物治疗。在本次入院时，胸部计算机断层扫描（CT）再次显示左侧胸腔积液，无其他明显病变。胸腔积液分析与之前的研究相似。进行了电视辅助胸腔镜胸膜活检以明确诊断。病理证实诊断为白塞病胸膜心包受累，我们在门诊用口服类固醇对患者进行了治疗。由于积液分析中腺苷脱氨酶（ADA）水平较高，白塞病的胸膜心包受累可能酷似结核性胸膜炎或心包炎。临床医生应牢记，白塞病可能表现为胸腔或心包积液，病理确诊有助于明确诊断。
