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A recurrent right heart thrombus in a patient with Behçet's disease
I Dincer1, R Dandachi, Y Atmaca
1Cardiology Department, Ankara University Faculty of Medicine, Ankara, Turkey. iremdincer@yahoo.com
Insights
Behçet's disease can manifest with cardiac thrombi, mimicking other conditions. Early diagnosis and combined immunosuppressive and anticoagulation therapy led to complete thrombus resolution in this case.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Background:
- Behçet's disease is a rare multisystem inflammatory disorder.
- Cardiac involvement in Behçet's disease is uncommon but can be severe.
- Recurrent oral ulcers, fever, weight loss, and fatigue are common presenting symptoms.
Observation:
- A patient presented with symptoms suggestive of systemic illness and a right ventricular mass.
- Initial diagnosis considered myxoma, but surgery revealed a thrombus.
- Recurrence of symptoms and a new right atrial thrombus were noted after anticoagulation therapy.
Findings:
- Re-evaluation led to a diagnosis of Behçet's disease based on mucocutaneous and systemic manifestations.
- The patient received thrombolytic, immunosuppressive, and anticoagulation therapy.
- Complete resolution of cardiac thrombi was observed via echocardiography after treatment.
Implications:
- This case highlights the importance of considering Behçet's disease in patients with unexplained cardiac thrombi and systemic symptoms.
- Aggressive management with combined therapies can effectively treat cardiac manifestations of Behçet's disease.
- Early recognition and treatment are crucial for improving outcomes in patients with Behçet's disease-related cardiac complications.
Abstract:
We report the case of a patient who was admitted to the immunology unit of our medical facility. The patient had a history of recurrent oral ulcers, low-grade fever, weight loss, and fatigue. Echocardiographic examination revealed a right ventricular mass that was initially thought to be a myxoma in an unusual location, and the patient was sent to surgery. Surgery revealed the mass to be a thrombus. After 5 months of anticoagulation therapy, the patient was readmitted to our institution with the same complaints, and a right atrial thrombus was found on echocardiographic examination. After a careful reevaluation of the patient's history and episodes of recurrent oral and genital ulcers, as well as the papulopustular lesions found on his first admission to hospital, Behçet's disease was diagnosed. The patient received thrombolytic therapy with a regression of thrombus, and continued with immunosuppressive and anticoagulation therapy. Five months later, echocardiographic examination showed complete disappearance of thrombus.