JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
REFERENCES
The second case exemplifies the challenge at diagnosing and pinpointing specific autoimmune syndromes amid multiple comorbidities. The new diagnosis of cirrhosis in this patient delayed the recognition of alternative explanations for a bleeding tendency. In addition, and of even greater importance, even a low dose steroid treatment for a different condition may have masked an underlying autoimmune disease, potentially making it impossible to arrive at a final definitive diagnosis. Close outpatient surveillance and good physician-to-physician communication will be paramount to provide the best early treatment should this patient experience new or recurrent symptoms. Hemoptysis in cases of BD is often secondary topulmonary artery aneurisms, and it may be massive.7-11 In a Chinese case series that reviewed 106 BD cases, 14% had pulmonary involvement. They found two patients who had microscopic pulmonary vascular involvement without macroscopic pulmonary artery aneurysm. In our reported case, mucosal petechiae were seen on bronchoscopy, and computed tomography was largely unrevealing. Biopsy was not performed due to concern for exacerbation of the bleeding. In conclusion, inflammatory diseases commonly present with difficult diagnostic and management dilemmas, particularly in the inpatient setting when patients develop serious manifestations of disease. The above reported cases exemplify airway involvement and hemoptysis with a multitude of differential diagnoses and complex medical decision processes. The study of such cases is useful not only for the management of similar autoimmune diseases, but also to develop skills that may prove valuable in the daily management of other complex medical cases.
1. Fitzgerald CWR, Adeeb F, Timon CV et al. Significant laryngeal destruction in a northern European cohort of Behcet's disease patients. Clin Exp Rheumatol 2015, 33(Suppl 94):S123-8. 2. Behcet H, Matteson EL. On relapsing, aphthous ulcers of the mouth, eye and genitalia caused by a virus. 1937 . Clin Exp Rheumatol 2010, 28(4 Suppl 60):S2-5. Epub 2010 Sep 23. 3. Davatchi F, Assaad-Khalil S, Calamia KT, et al. The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol . 2014 Mar;28(3):338-47. doi:10.1111/jdv.12107. Epub 2013 Feb 26. PubMed PMID: 23441863. 4. Webb CJ, Moots RJ, Swift AC. Ear, nose and throat manifestations of Behcet's disease: a review. J Laryngol Otol 2008, 122:1279-83. 5. Gross M, Ben-Chetrit E. Laryngeal involvement in Behcet's disease - a challenge for treatment. Clin Rheumatol 2013, 32(Suppl 1):S75-7. 6. Seyahi E, Yazici H. Behcet's syndrome: pulmonary vascular disease. Curr Opin Rheumatol 2015, 27:18-23. 7. Doss J, England J, Fuchs H. Coughing up blood: Behcet's disease. Am J Med 2014, 127(5):386-9. 8. Lacombe P, Qanadli SD, Jondeau G et al. Treatment of hemoptysis in Behcet syndrome with pulmonary and bronchial embolization. JVIR 1997, 8:1043- 7. 9. LeeW-Y, Hoon CS, Kim HR. Massive hemoptysis caused by atypical Behcet's disease. Korean J Thorac Cardiovasc Surg 2014, 47:178-80. 10. Nordstrom E, Fisher M. The great masquerader: Behcet's disease. BMJ Case Rep 2014, doi:10.1136/bcr-2013-202919 11. Zhang X, Dai H, Ma Z et al. Pulmonary involvement in patients with Behcet's disease: report of 15 cases. Clin Respir J 2015, 9:414-22. DOI:10.1111/ crj.12153.
Ivan Saraiva, MD and Goutham Talari, MD, are affiliated with the Division of Hospital Medicine, University of Kentucky, Lexington, KY.
Dr. Saraiva can be reached at ivansaraiva@uky.edu.
78 La State Med Soc VOL 170 MAY/JUNE 2018
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