Behçet's Disease and Autoimmune Atrophic Gastritis: An Incidental Finding

Behçet's disease (BD) is a systemic inflammatory condition causing oral ulcers, genital sores, eye inflammation, and skin lesions. Autoinflammatory and autoimmune disorders are chronic immune system activation leading to tissue inflammation. Current evidence suggests that BD is at the intersection of autoimmune and autoinflammatory syndromes, with some findings suggesting an autoinflammatory nature. Oral aphthous ulcers are the commonest initial manifestation of the disease. Gastric manifestations in BD are infrequent. The usually seen finding in the stomach is either ulcers or gastritis, presenting as epigastric pain. BD has been linked with several autoimmune diseases; however, it has not yet been seen with autoimmune atrophic gastritis. We present a case of a 62-years-old male patient presenting for oral aphthous ulcers with vague abdominal pain, epigastric discomfort, and postprandial nausea. The patient was positive for HLA-B5 alleles, leading to a diagnosis of BD. Gastroscopy and colonoscopy were done to investigate a probable etiology for this patient's epigastric discomfort and abdominal pain. Gastroscopy showed multiple erosions at the level of the fundus and atrophic folds at the level of the body of the stomach, but no important findings were seen on colonoscopy. Furthermore, a gastric biopsy was done and confirmed the presence of autoimmune atrophic gastritis at the level of the fundus and antrum of the stomach which is atypical in BD that is commonly associated with aphthous ulcerations at the level of the terminal ileum. To our knowledge, this is the first case reported, which should prompt for further investigation behind the mechanism linking these two diseases.