VASCULAR BEHÇET - A CHALLENGE IN ANTICOAGULATION
- Ana Neves, Portugal
Abstract
Background and Aims
Behçet’s disease (BD) is a systemic autoinflammatory disorder characterized by recurrent oral ulcers, genital ulcers, ophthalmologic, musculoskeletal, vascular and cutaneous manifestations. Vascular involvement in BD is present in up to 40% of cases, 75% of which are venous, whereas the other 25% are arterial.
Methods
Herein, we present a 36-year-old male with previous medical history of psoriasis, and deep vein thrombosis (DVT) of the right common iliac vein following a pyeloplasty. Then, a year later, with ongoing anti-vitamin K treatment, he made a new DVT of the right popliteal and distal femoral veins, so anticoagulation was switched to enoxaparin for 1.5 months, and later switched to dabigatran. One year later, with a new episode of left popliteal DVT, it was decided to keep anticoagulation with enoxaparin.
Results
In association, he presented a migratory tibio-tarsal arthritis, oral aphthosis and erythema nodosum, which led us to the diagnosis of BD. Immunosuppressive therapy was started with corticosteroid and methotrexate (regarding his past history of psoriasis), without further episodes of thrombosis until then.
Conclusions
While the role of immunosuppressive therapy is well acknowledged, a controversy exists regarding the value of anticoagulant treatment, and the usefulness of anticoagulation in different vascular manifestations related to BS is still unclear. However, the presence of DVT in atypical sites other than the lower extremities, should raise concern over new episodes of DVT in the future. Therefore, anticoagulation should be considered in these patients associated with immunosupressive therapy, which is the key for a successful therapy.