Undiagnosed Behçet's Disease Complicated by Multiple Pseudoaneurysms and COVID-19 Infection

Abstract

Behcet's disease (BD) is a rare multiorgan systemic disorder characterized by recurrent episodes of acute inflammation. Involvement of the vascular system, gastrointestinal tract, and central nervous system portends a poor prognosis.

We report the case of a 54-year-old man who presented with a 2-week history of symptoms attributable to infrarenal aortic and left tibioperoneal trunk pseudoaneurysms, defined by CT angiography which also revealed right lower lobe pulmonary artery (PA) and right anterior tibial arterial aneurysms. A prior history of recurrent oral ulceration, periodic fever, cerebral venous sinus thrombosis, and aseptic endocarditis with pulmonary emboli invoked a diagnosis of BD. Immunosuppression was commenced immediately, following synchronous endovascular and open arterial intervention, except the PA aneurysm.

He developed a fever and cough 8 days postoperatively as a consequence of COVID-19 infection from which he recovered without complications.

The management of the patient's four aneurysms in different vascular territories and postoperative COVID-19 infection in the presence of mandatory immunosuppression are discussed.

Keywords

COVID-19 - Behcet's disease - pseudoaneurysm - SARS-CoV-2 - immunosuppression - endovascular repair - anastomotic complication

Note

This case was presented at the rheumatology meeting in the British Society for Rheumatology, in the Rheumatology Advances in Practice journal on October 1, 2020, and the abstract from the presentation was published in Rheumatology Advances in Practice, volume 4, issue supplement_1. Cited: Rameez Arif, Caroline Cardy, O05 Active Bechet's with life threatening arterial disease, complicated by concurrent COVID-19 infection at the peak of the COVID-19 pandemic: did immunosuppression help or hinder? Rheumatology Advances in Practice, volume 4, issue supplement_1, October 2020, rkaa053.004, https://doi.org/10.1093/rap/rkaa053.004.

Publication History

Article published online:
25 August 2021

• References

• 1 Koç Y, Güllü I, Akpek G. et al. Vascular involvement in Behçet's disease. J Rheumatol 1992; 19 (03) 402-410
• 2 El-Ghobashy N, El-Garf K, Abdo M. Arterial aneurysms in Behcet's disease patients: Frequency, clinical characteristics and long-term outcome. Egypt Rheumatol 2019; 41 (04) 309-312
• 3 Hatemi G, Christensen R, Bang D. et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis 2018; 77 (06) 808-818
• 4 Alpagut U, Ugurlucan M, Dayioglu E. Major arterial involvement and review of Behcet's disease. Ann Vasc Surg 2007; 21 (02) 232-239
• 5 Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 2011; 8 (02) 92-102
• 6 Kim SW, Lee DY, Kim MD. et al. Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet's disease. J Vasc Surg 2014; 59 (03) 608-614
• 7 Ugurlucan M, Sendil S, Sayin OA. et al. Spontaneous superficial femoral artery pseudoaneurysm in Behcet's disease. Case Rep Med 2014; 2014: 860243
• 8 Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID - 19. Accessed July 3, 2021 at: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
• 9 Thng ZX, De Smet MD, Lee CS. et al. COVID-19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs. Br J Ophthalmol 2021; 105 (03) 306-310