P01-228-Behcet's syndrome comorbid with bipolar disorder: A case report

IntroductionBehcet's Syndrome is a chronic inflammatory disorder of unknown etiology, characterized by aphthous lesions and recurrent ulceration of the mouth, genitals and uveitis.ObjectivesThe central nervous system is involved in about 20% of cases.AimsOnly few reports deal with affective symptoms associated with Behcet's syndrome.MethodsWe report a case of a 43 year old male with Neuro-Behcet's Syndrome that presents with a psychotic manic attack. He developed Behcet's Syndrome at the age of 23, with recurrent uveitis and aphthous lesions in the mouth, painful ulcers in the genitalia and erythema nodosum. HLA-B 5 was positive.ResultsHe was treated with azothioprine 150 mg/day for 13 years and prednole 100 mg/day during uveitis attacts for a week. At the age of 37 a sudden occurrence of right hemiparesia due to cerebrovascular accidence salicylic acid 100mg/day, siclosporine 150 mg/day, piracetame 1600mg/day were administered. He presented to psychiatry clinic in manic episode with euphoric mood, psychomotor agitation, talkativeness, decreased need for sleep, excessive buying and he had an unrealistical thought that he was a player of a famous soccer team. He was diagnosed as bipolar I disorder, according to DSM-IV. This was the patient's first admission and the symptoms which were continuing for 6 years exaggerated during uveitis attacks.Psychiatric examination releaved that increaced psychomotor activity, hypomaniac affect, amount and affect speed of speech affect, increased associations, grandiose delusions.ConclusionThere are a few reports dealing with bipolar disorder as an entity related to Behcet's syndrome.

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Behçet’s syndrome

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.191105_update_002 ◽

2010 ◽

pp. 3684-3687

Author(s):

Hasan Yazici ◽

Sebahattin Yurdakul ◽

Izzet Fresko

Keyword(s):

Clinical Laboratory ◽

Central Nervous System Involvement ◽

Arterial Occlusion ◽

Inflammatory Disorder ◽

Behçet’S Syndrome ◽

Laboratory Findings ◽

Behçet's Syndrome ◽

Oral Ulcers ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

Behçet’s syndrome is an inflammatory disorder of unknown aetiology that involves arteries and veins of all sizes. Most cases are from the countries around the Mediterranean basin, the Middle East and east Asia, with the highest prevalence in Turkey. Clinical features—the disease typically presents in the second and third decades with recurrent oral ulcers (98% of cases), genital ulcers (85%), acneiform lesions (85%), pathergy reaction (60% in some countries), erythema nodosum (50%), uveitis (50%), arthritis (50%), thrombophlebitis (30%), and less commonly with arterial occlusion/aneurysm, central nervous system involvement or gastrointestinal lesions. A relapsing/remitting course is usual. Disease is more severe and mortality is higher in men. The diagnosis is clinical, laboratory findings are nonspecific and there is no specific diagnostic test for Behçet’s syndrome....

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Resistant bipolar disorder precipitated by Behcet's syndrome

Bipolar Disorders ◽

10.1111/j.1399-5618.2004.00114.x ◽

2004 ◽

Vol 6 (3) ◽

pp. 260-263 ◽

Cited By ~ 6

Author(s):

B Alevizos ◽

C Anagnostara ◽

GN Christodoulou

Keyword(s):

Bipolar Disorder ◽

Behçet’S Syndrome ◽

Behçet's Syndrome ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

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Modulation of gut microbiota through nutritional interventions in Behçet's syndrome patients (the MAMBA study): study protocol for a randomized controlled trial

10.21203/rs.2.19500/v1 ◽

2019 ◽

Author(s):

Giuditta PAGLIAI ◽

Monica DINU ◽

Claudia FIORILLO ◽

Matteo BECATTI ◽

Silvia TURRONI ◽

...

Keyword(s):

Gut Microbiota ◽

Mediterranean Diet ◽

Clinical Manifestations ◽

Unknown Etiology ◽

Processed Meat ◽

Behçet’S Syndrome ◽

Behçet's Syndrome ◽

Wide Range ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

Abstract Background Behçet's syndrome (BS) is a systemic inflammatory disorder of unknown etiology, characterized by a wide range of potential clinical manifestations. Recent evidences suggest that the gut microbiota (GM) in BS shows low biodiversity with a significant depletion in butyrate producers. The aim of the present project is to investigate whether a dietary intervention could ameliorate the clinical manifestations and modulate the GM of patients with BS.Methods This is a randomized, open, cross-over study involving 90 BS patients who will be randomized to follow a 3-months dietary profile with either: lacto-ovo-vegetarian diet (VD), Mediterranean diet (MD) or Mediterranean diet supplemented with butyrate (MD-Bt). The VD will contain inulin and resistant starch-rich foods, eggs and dairy, in addition to plant-based food, but will not contain meat, poultry or fish. The MD will contain all food categories and will provide 2 portions per week of fish and 3 portions per week of fresh and processed meat. The MD-Bt will be similar to the MD but supplemented with 1.8 g/day of oral butyrate. The three different dietary patterns will be isocaloric and related to subject’s nutritional requirements. Anthropometric measurements, body composition, blood and fecal samples will be obtained from each participant at the beginning and at the end of each intervention phase. The primary outcomes will be represented by the change from baseline of the BS gastrointestinal and systemic symptoms. Changes from baseline of GM composition, SCFA production, inflammatory and antioxidant profile will be considered as secondary outcomes.Discussion BS is a rare disease, and, actually, not all the available treatments are target therapies. A supportive treatment based on dietary and lifestyle issues, able to restore immune system homeostasis, could have a high impact on costs sustainability for the treatment of such a chronic and disabling inflammatory condition.

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Modulation of gut microbiota through nutritional interventions in Behçet's syndrome patients (the MAMBA study): study protocol for a randomized controlled trial

10.21203/rs.2.19500/v2 ◽

2020 ◽

Author(s):

Giuditta PAGLIAI ◽

Monica DINU ◽

Claudia FIORILLO ◽

Matteo BECATTI ◽

Silvia TURRONI ◽

...

Keyword(s):

Gut Microbiota ◽

Mediterranean Diet ◽

Clinical Manifestations ◽

Unknown Etiology ◽

Processed Meat ◽

Behçet’S Syndrome ◽

Behçet's Syndrome ◽

Wide Range ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

Abstract Background: Behçet's syndrome (BS) is a systemic inflammatory disorder of unknown etiology, characterized by a wide range of potential clinical manifestations. Recent evidences suggest that the gut microbiota (GM) in BS shows low biodiversity with a significant depletion in butyrate producers. The aim of the present project is to investigate whether a dietary intervention could ameliorate the clinical manifestations and modulate the GM of individuals with BS. Methods: This is a randomized, open, cross-over study involving 90 BS individuals who will be randomized to follow a 3-months dietary profile with either: lacto-ovo-vegetarian diet (VD), Mediterranean diet (MD) or Mediterranean diet supplemented with butyrate (MD-Bt). The VD will contain inulin and resistant starch-rich foods, eggs and dairy, in addition to plant-based food, but will not contain meat, poultry or fish. The MD will contain all food categories and will provide 2 portions per week of fish and 3 portions per week of fresh and processed meat. The MD-Bt will be similar to the MD but supplemented with 1.8 g/day of oral butyrate. The three different dietary patterns will be isocaloric and related to participants’ nutritional requirements. Anthropometric measurements, body composition, blood and fecal samples will be obtained from each participant at the beginning and at the end of each intervention phase. The primary outcomes will be represented by the change from baseline of the BS gastrointestinal and systemic symptoms. Changes from baseline of GM composition, SCFA production, inflammatory and antioxidant profile will be considered as secondary outcomes. Discussion: BS is a rare disease, and, actually, not all the available treatments are target therapies. A supportive treatment based on dietary and lifestyle issues, able to restore immune system homeostasis, could have a high impact on costs sustainability for the treatment of such a chronic and disabling inflammatory condition.

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Pulmonary artery thrombosis as the first presentation of Behçet’s syndrome: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02931-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ziyad Alakkas ◽

Waad Kazi ◽

Mohamed Mattar ◽

Eman Abdul Wahhab Salem ◽

Naglaa Fawzy Seleem

Keyword(s):

Pulmonary Artery ◽

Morbidity And Mortality ◽

Vascular Involvement ◽

Unknown Etiology ◽

Behçet’S Syndrome ◽

Behçet's Syndrome ◽

Artery Thrombosis ◽

Behcet’S Syndrome ◽

Genital Ulcers ◽

Behcet's Syndrome

Abstract Background Behçet’s syndrome is a type of systemic chronic vasculitis of unknown etiology, frequently characterized by recurrent oral and genital ulcers and uveitis. It is less commonly characterized by arthritis and skin, vascular, and gastrointestinal involvements. Behçet’s syndrome affects various sizes of vessels by perivascular infiltration and vasculitis. Unlike other classic types of vasculitis, Behçet’s syndrome patients can present with both arterial and venous involvement. Although vascular Behçet’s syndrome is found in only around 15% of Behçet’s syndrome patients, it is the major cause of morbidity and mortality among them. Furthermore, although deep venous thrombosis has high incidence in Behçet’s syndrome patients, pulmonary artery thrombosis is an uncommon complication. Combining the findings of this and previous case reports of pulmonary artery thrombosis in Behçet’s syndrome patients, we sought to determine the best treatment options for pulmonary artery thrombosis in Behçet’s syndrome patients. Case presentation We present the case of a 22-year-old Arabian male who was admitted to an emergency department with acute chest pain, dyspnea, and hemoptysis for 2 weeks. He gave a long history of recurrent oral and genital ulcers for the last 4 months but without seeking medical advice. Spiral computed tomography showed arterial filling defects with a pulmonary nodule for which the presence of a pulmonary artery aneurysm ruled out. The lung perfusion scan showed multiple pulmonary perfusion defects. After excluding common infectious diseases such as tuberculosis and brucellosis, a diagnosis of Behçet’s syndrome with pulmonary artery thrombosis was made. Steroids with enoxaparin were initiated. The patient was discharged later on prednisolone (tapering dose) with adalimumab and apixaban. He was on regular follow-up for the next 9 months. Conclusions Vascular involvement in Behçet’s syndrome is a major contributor to morbidity and mortality of Behçet’s syndrome patients. Consequently, early detection of vascular involvement has a major impact on the prognosis of patients with Behçet’s syndrome.

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Behçet’s syndrome

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0462 ◽

2020 ◽

pp. 4579-4584

Author(s):

Sebahattin Yurdakul ◽

Izzet Fresko ◽

Hasan Yazici

Keyword(s):

Clinical Laboratory ◽

Central Nervous System Involvement ◽

Arterial Occlusion ◽

Inflammatory Disorder ◽

Behçet’S Syndrome ◽

Laboratory Findings ◽

Behçet's Syndrome ◽

Oral Ulcers ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

Behçet’s syndrome is an inflammatory disorder of unknown aetiology that involves arteries and veins of all sizes. Most cases are from the countries around the Mediterranean basin, the Middle East, and East Asia, with the highest prevalence in Turkey. It typically presents in the second and third decades with recurrent oral ulcers (98% of cases), genital ulcers (85%), acneiform lesions (85%), pathergy reaction (60% in some countries), erythema nodosum (50%), uveitis (50%), arthritis (50%), thrombophlebitis (30%), and less commonly with arterial occlusion/aneurysm, central nervous system involvement, or gastrointestinal lesions. A relapsing/remitting course is usual. Disease is more severe and mortality is higher in men. The diagnosis is clinical, laboratory findings are non-specific, and there is no specific diagnostic test for Behçet’s syndrome.

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Behcet’s Syndrome resembling complex perianal Crohn’s Disease

SAGE Open Medical Case Reports ◽

10.1177/2050313x211009717 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110097

Author(s):

Ali P Mourad ◽

Marie Shella De Robles ◽

Robert DR Winn

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Perianal Fistula ◽

Inflammatory Disorder ◽

Behçet’S Syndrome ◽

Left Groin ◽

Behçet's Syndrome ◽

Organ Systems ◽

Behcet’S Syndrome ◽

Behcet's Syndrome

Behcet’s syndrome is a systemic inflammatory disorder that involves several organ systems and is exceptionally rare in the Western world. The diagnosis is frequently difficult as it resembles several other disease processes. A 23-year-old male with a previous presumptive diagnosis of Crohn’s disease presented to our unit with genital ulceration. This is on a background of recurrent perianal abscesses requiring surgical drainage and seton placement. He subsequently developed a complex perianal fistula extending from the rectum to the perineum and left groin. After drainage and an unsuccessful trial of biologic immunosuppressive therapy, he developed several papulopustular cutaneous lesions and oral ulcerations. The diagnostic criteria for Behcet’s syndrome was met and he was referred to a rheumatologist for ongoing management.

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