Radiological neuro-Behçet's associated with bipolar disorder: first presentation of a multisystem disease

Behçet's disease is a chronic, relapsing, systemic inflammatory disease affecting the orogenital mucosa, eyes, joints, blood vessels, nervous system and intestines. The prevalence of neurological involvement varies geographically and can include psychiatric manifestations. Current evidence for a causal association between Behçet's disease and bipolar disorder is limited to a small number of case reports. We report a case of a patient with a recent diagnosis of bipolar disorder who was subsequently diagnosed with Behçet's disease. The 38-year-old male presented with a 6-month history of right eye visual blurring, 5-month history of mouth ulcers and 3 months of genital ulceration. His inflammatory markers were raised. An MRI of the brain was conducted in the absence of any focal neurological signs or symptoms owing to his past psychiatric history. The MRI showed changes in the medial aspect of the right temporal lobe highly suspicious of neuro-Behçet's disease. His inpatient care was coordinated with neurology, rheumatology, ophthalmology and psychiatry teams, and he was later discharged with outpatient follow up owing to a clinical improvement on high-dose steroids. This case shows that, although widely unrecognised, neuro-Behçet's can occur in the absence of focal neurology. Additionally, neuro-Behçet's should be considered in patients with bipolar disorder presenting with symptoms suggestive of Behçet's disease. The case emphasises how patients presenting with ulceration, mood disorder and visual changes should not have these symptoms considered in isolation and multisystem disease should be considered. Furthermore, the coordinated multidisciplinary approach required for the care of patients with Behçet's disease is demonstrated.