Recurrent myocarditis in the context of Behçet's disease: a case report

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Behçet's syndrome is a rare multisystemic vasculitis of unknown cause.
• Cardiac involvement, though uncommon, can manifest as pericarditis, valvular issues, or aneurysms.
• Myocarditis is a particularly rare cardiac complication of Behçet's syndrome.

Observation:

• A 26-year-old man presented with recurrent chest pain and elevated cardiac biomarkers, initially presumed to be viral myocarditis.
• Physical examination revealed mucocutaneous lesions (aphthosis, folliculitis, hidradenitis) and fever, prompting a re-evaluation.
• Diagnostic workup included ECG, echocardiography, coronary angiography, and cardiac MRI, with PET scans used to assess myocardial activity.

Findings:

• The patient was diagnosed with Behçet's syndrome with cardiac and mucocutaneous involvement.
• Initial treatment with colchicine and anti-inflammatories provided partial relief, but immunosuppressive therapy (corticosteroids, azathioprine) was required for full recovery.
• Positron emission tomography confirmed myocardial inflammation, which resolved with treatment.

Implications:

• This case underscores the importance of considering Behçet's syndrome in patients with recurrent myocarditis, especially those with mucocutaneous findings.
• Early and accurate diagnosis is crucial for initiating appropriate immunosuppressive therapy.
• Successful management highlights the efficacy of a tailored immunosuppressive approach for cardiac Behçet's syndrome, even when optimal strategies are uncertain.