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[Myocardial infarction in Behçet's disease]
D u Le Thi Huong1, B Wechsler, J C Kahn
1Service de Médecine interne, hôpital de la Pitié, Paris.
Insights
This case report details a young male with Behçet
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Immunology
Background:
- Behçet's disease is a rare multisystem inflammatory disorder.
- Myocardial infarction (MI) is an uncommon complication, particularly in young patients.
- Recurrent venous thrombosis is a known manifestation of Behçet's disease.
Observation:
- A 23-year-old male with a history of Behçet's disease and recurrent venous thrombosis presented with myocardial infarction.
- Coronary arteriography revealed stenosis in the anterior interventricular artery and occlusion of the first diagonal artery.
- No significant traditional vascular risk factors were identified, apart from moderate cigarette smoking.
Findings:
- This case adds to the approximately 10 reported instances of MI associated with Behçet's disease.
- The affected individuals are typically young males, with MI occurring late in the disease course.
- Leukocytoclastic vasculitis in Behçet's disease is implicated in vascular stenosis, thrombosis, and aneurysm formation.
Implications:
- Behçet's disease should be considered a potential cause of myocardial infarction in young individuals, even without typical risk factors.
- Further research into the physiopathological mechanisms, including endothelial and systemic fibrinolytic activity, is warranted.
- Understanding these mechanisms may lead to improved diagnostic and therapeutic strategies for cardiovascular complications in Behçet's disease.
Abstract:
A case of myocardial infarction in a 23-year old male patient with Behçet's disease is reported. The infarction occurred 4 years after the onset of the disease, which had been marked by recurrent venous thrombosis. Coronary arteriography showed stenosis of the anterior interventricular artery and occlusion of the first diagonal artery; the other coronary vessels were normal. A search for vascular risk factors, including haemostasis, was undertaken, yielding only moderate cigarette-smoking. About 10 cases of myocardial infarction associated with Behçet's disease have been reported. They concerned young, usually male subjects. Infarction usually occurred late in the course of the disease, and vascular risk factors were seldom elicited. The leukocytoclastic vasculitis of Behçet's disease alone may be responsible for stenosis, thrombosis and false arterial aneurysms, as shown by anatomical studies. The physiopathological mechanisms involved (reduction of endothelial or systemic fibrinolytic activity, rise in fibrinogen and factor VIII) are still unclear; we believe that these abnormalities are inconstant. Behçet's disease may be regarded as a possible cause of myocardial infarction in young subjects.