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Coeliac artery dissection as a rare manifestation of Behcet's disease
Anthony J Ocon1, Vivek R Mehta2, Ruben Peredo-Wende3
1Internal Medicine, Albany Medical College, Albany, New York, USA.
Insights
Behcet
Area of Science:
- Vascular Medicine
- Rheumatology
- Gastroenterology
Background:
- Behcet's disease is a rare multisystemic vasculitis.
- Arterial dissection is an uncommon but serious complication of Behcet's disease.
Observation:
- A 42-year-old male with Behcet's disease presented with severe abdominal pain and hypertension.
- CT angiogram revealed acute dissection of the coeliac artery and its branches, along with arterial wall thickening suggestive of vasculitis.
Findings:
- The case highlights a rare instance of coeliac artery dissection in a patient with Behcet's disease.
- Successful management involved a combination of antihypertensive and anti-inflammatory medications.
Implications:
- This case underscores the importance of considering arterial dissection in Behcet's disease patients presenting with abdominal pain.
- Arterial wall inflammation and hypertension are potential contributing factors to dissection in this condition.
Abstract:
Behcet's disease is a multisystemic vasculitis. Arterial involvement in the form of acute dissection is rare. A 42-year-old Lebanese man with Behcet's disease presented with severe abdominal pain. On exam, blood pressure was 162/104 mm Hg, and he exhibited epigastric tenderness. CT angiogram demonstrated an acute dissection of the coeliac artery trunk, common hepatic artery and proper hepatic arteries, with asymmetric thickening of the proximal left subclavian artery and circumferential thickening of the abdominal infrarenal aorta suggestive of vasculitis. Treatment included intravenous clevidipine, nitroprusside and methylprednisolone, which transitioned to oral metoprolol, amlodipine and prednisone. He responded well. Arterial dissections have been described with Behcet's. We report a coeliac artery aneurysm in association with a flare of Behcet's disease. Arterial wall inflammation combined with the sheering forces of hypertension likely predisposes to arterial dissection.