Behçet's Disease and Tuberculosis: A Complex Relationship | JoVE Visualize

Area of Science:

Immunology
Rheumatology
Infectious Diseases

Background:

Behçet's disease (BD) is a systemic vasculitis with unknown pathogenesis, often involving orogenital ulcers and systemic manifestations.
Patients with BD exhibit immune defects, increasing their susceptibility to infections like tuberculosis (TB).
The potential role of pathogens, including Mycobacterium tuberculosis, as triggers or co-factors in BD is recognized.

Purpose of the Study:

To report a case of a 70-year-old woman diagnosed with Behçet's disease who simultaneously presented with cutaneous tuberculosis.
To highlight the diagnostic challenges and clinical presentation of co-existing BD and tuberculosis.
To emphasize the importance of considering tuberculosis in BD patients, especially with unusual presentations like cutaneous abscesses.

Main Methods:

Case report of a 70-year-old female patient with a history of recurrent oral aphthae and inflammatory arthritis.
Diagnostic work-up included exclusion of other causes for systemic manifestations, HLA B51 genotyping, and evaluation of extensive thrombosis.
Identification of Mycobacterium tuberculosis from cutaneous abscess cultures after recurrent negative tuberculosis work-ups.

Main Results:

The patient was diagnosed with Behçet's disease based on clinical criteria including recurrent oral aphthae, inflammatory arthritis, extensive venous thrombosis, positive HLA B51, and colon ulceration.
Simultaneously, the patient developed progressive cutaneous abscesses.
Mycobacterium tuberculosis was ultimately isolated from abscess cultures, confirming cutaneous tuberculosis co-existing with Behçet's disease.

Conclusions:

Behçet's disease patients, without anti-TNF-alpha therapy, are prone to tuberculosis due to impaired cell-mediated immunity.
Differentiating BD from pseudo-Behçet's syndrome at tuberculosis onset is critical, as Behçet-like symptoms may resolve with anti-bacillar therapy.
Cutaneous tuberculosis, though rare, presents diversely, necessitating high clinical suspicion and repeated microbiological testing for diagnosis.