Department of Internal Medicine, Division of Rheumatology, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of vascular surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Curr Rheumatol Rev. 2022;18(1):83-87. doi: 10.2174/1573397117666210920154400.
Behçet's disease (BD) is a complex vasculitis with some vascular manifestations including venous thrombosis, arterial thrombosis/aneurysm/pseudoaneurysm, and co-associated venous thrombosis and arterial lesions. We present two patients with Behçet's disease came with progressive both arterial and venous involvement.
The first patient was a young man with recurrent oral aphthosis and skin folliculitis and referred with complaint of new abdominal pain and 2 months severe headache. He had not referred to a physician due to COVID-19 pandemic until that time. In addition, he gradually developed a lower extremity edema and eventually was diagnosed with BD complicated with brain sagittal sinus vein thrombosis, abdominal aortic aneurysms and aortitis and deep vein thrombosis (DVT) of femoral vein. The second patient was a young woman with previous history of uveitis, DVT and recurrent oral and genital aphthosis presented with a large inguinal mass due to large iliac artery pseudoaneurysm impending to rupture, and after the operation, due to poor follow-up, developed a new femoral DVT.
It seems the same inflammatory process is responsible for arterial and venous involvement in patients with BD, so it should be considered that involvement in one side (venous/arterial) can be a risk factor for the other side (venous/arterial) and early immunosuppressive treatment should always be considered to improve the prognosis.
白塞病(BD)是一种复杂的血管炎,其血管表现包括静脉血栓形成、动脉血栓形成/动脉瘤/假性动脉瘤,以及伴发的静脉血栓形成和动脉病变。我们报告了两例以进行性动静脉受累为特征的白塞病患者。
第一例患者为年轻男性,反复出现口腔阿弗他溃疡和皮肤毛囊炎,因新发腹痛和 2 个月严重头痛就诊。由于当时正处于 COVID-19 大流行期间,他没有去看医生。此外,他逐渐出现下肢水肿,最终被诊断为 BD 合并脑矢状窦静脉血栓形成、腹主动脉瘤和主动脉炎以及股静脉深静脉血栓形成(DVT)。第二例患者为年轻女性,既往有葡萄膜炎、DVT 和复发性口腔和生殖器阿弗他溃疡病史,因即将破裂的髂总动脉瘤引起的巨大腹股沟肿块就诊,手术后由于随访不佳,又出现新的股 DVT。
似乎相同的炎症过程导致 BD 患者的动静脉受累,因此应考虑一侧(静脉/动脉)受累可能是另一侧(静脉/动脉)受累的危险因素,应始终考虑早期免疫抑制治疗以改善预后。