warfarin and Behcet-Syndrome

Adamantiades-Behçet's disease (ABD) is a relapsing vasculitis of unknown aetiology and variable clinical manifestations. The syndrome can be presented in a myriad of ways and can involve nearly every organ. Although vascular involvement is not included among the ABD diagnostic criteria, it is a unique clinical manifestation in adults with a potentially devastating outcome. We report an ABD case, presenting with a thrombotic occlusion of the inferior vena cava. The authors review the recent literature, emphasizing the spectrum of vascular manifestations accompanying Behçet's disease.

Topics: Adult; Aged; Anticoagulants; Behcet Syndrome; Budd-Chiari Syndrome; Diagnosis, Differential; Fibrinolytic Agents; Humans; Male; Radiography; Vena Cava, Inferior; Warfarin

Topics: Acetazolamide; Adult; Anticoagulants; Behcet Syndrome; Blood Coagulation Factors; Consciousness Disorders; Drug Synergism; Female; Glaucoma, Angle-Closure; Humans; Ibuprofen; International Normalized Ratio; Lupus Coagulation Inhibitor; Metrorrhagia; Thrombophilia; Warfarin

High mobility group box- 1 (HMGB- 1) is a nuclear protein acting as a proinflammatory molecule. The serum HMGB- 1 levels were found elevated in chronic inflammatory diseases. In this cross-sectional study, serum HMGB- 1 levels in Behcet's disease (BD) patients and healthy controls (HC) were studied. Also, its association with disease activity scores and clinical findings were evaluated.. Ninety BD patients and 50 age-sex matched HC were included in the study. Disease activity scores were assessed by Behcet Disease Current Activity Form (BDCAF) and Behcet Syndrome Activity Score (BSAS). Serum HMGB- 1 levels were measured using a commercial ELISA kit. A p value of < 0.05 was considered to be statistically significant.. Serum HMGB- 1 levels were significantly higher in BD than in HC (43.26 pg/mL and 16.73 pg/mL; p < 0.001, respectively). Serum HMGB- 1 levels were statistically significantly associated with presence of erythema nodosum (EN) and genital ulcers in the last one month prior to recruitment (p = 0.041 and p < 0.001, respectively). BDCAF and BSAS scores were positively correlated with serum HMGB- 1 level ( p = 0.03 and p = 0.02, respectively).. HMGB - 1 may play a role in the development of BD. Also, due to its positive correlation with disease activity indices, it can be used as a novel disease activity parameter in BD.

Topics: Aorta, Abdominal; Behcet Syndrome; Case-Control Studies; Cross-Sectional Studies; Humans; Renal Dialysis; Vascular Calcification; Warfarin

Topics: Azathioprine; Behcet Syndrome; Colchicine; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Scrotum; Varicose Veins; Warfarin

Topics: Behcet Syndrome; Humans; Thrombosis; Vasculitis; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Behcet Syndrome; Humans; Thrombosis; Warfarin

Topics: Abdominal Pain; Abscess; Adalimumab; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Budd-Chiari Syndrome; Female; Fever; Humans; Liver Abscess; Splenic Diseases; Suction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin; Young Adult

Behçet's disease is an inflammatory systemic disorder, characterized by a relapsing and remitting course, it manifests with oral and genital ulcerations, skin lesions, uveitis, vasculitis, central nervous system and gastrointestinal involvement. The main histopathological finding is widespread vasculitis of the arteries and veins. Therapy is variable and depends largely on the severity of the disease and organ involvement. There is common practice to treat with anticoagulation in patients suffering from vessel thrombosis, but there are no control trials to support this tendency. Anticoagulation treatment can cause major bleeding events in patients suffering from aneurysms. In this case report we describe a treatment dilemma in a patient suffering from deep vein thrombosis and pulmonary aneurysms.

Topics: Adolescent; Aneurysm; Anticoagulants; Behcet Syndrome; Biological Therapy; Cyclophosphamide; Fibrinolytic Agents; Glucocorticoids; Hemorrhage; Humans; Immunosuppressive Agents; Male; Medication Therapy Management; Pulmonary Artery; Radiography; Secondary Prevention; Severity of Illness Index; Treatment Outcome; Ultrasonography; Urokinase-Type Plasminogen Activator; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Behcet Syndrome; Diagnosis, Differential; Epilepsy, Tonic-Clonic; Headache; Heparin; Humans; Male; Middle Aged; Muscle Weakness; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

The cytochrome P450 enzyme CYP2C9 metabolizes several important drugs, such as warfarin and oral antidiabetic drugs. The enzyme is polymorphic, and all known alleles, for example, CYP2C9*2 and*3, give decreased activity. Ultra-high activity of the enzyme has not yet been reported.. We present a patient with Behçet's disease who required treatment with high doses of phenytoin. When fluconazole, a potent inhibitor of CYP2C9, was added to the treatment regimen, the patient developed ataxia, tremor, fatigue, slurred speech and somnolence, indicating phenytoin intoxication. On suspicion of ultra-high activity of CYP2C9, a phenotyping test for CYP2C9 with losartan was performed.. The patient was shown to have a higher activity of CYP2C9 than any of the 190 healthy Swedish Caucasians used as controls.. Our finding of an ultrarapid metabolism of losartan and phenytoin may apply to other CYP2C9 substrates, where inhibition of CYP2C9 may cause severe adverse drug reactions.

Topics: Alleles; Angiotensin II Type 1 Receptor Blockers; Anticonvulsants; Aryl Hydrocarbon Hydroxylases; Ataxia; Behcet Syndrome; Case-Control Studies; Cytochrome P-450 CYP2C9; Cytochrome P-450 Enzyme System; Disorders of Excessive Somnolence; Dose-Response Relationship, Drug; Fatigue; Female; Fluconazole; Humans; Losartan; Middle Aged; Pharmaceutical Preparations; Phenotype; Phenytoin; Polymorphism, Genetic; Speech Intelligibility; Warfarin

Bleeding in patients on oral anticoagulant treatment is not uncommon, but hemarthrosis has been described only in few patients. This is a case report of a patient on warfarin due to recurrent venous and arterial thromboembolism, with congenital thrombophilia and Behcet's disease. This report presents knee hemarthrosis during warfarin therapy, reviews the literature and discusses this issue.

Topics: Anticoagulants; Behcet Syndrome; Female; Hemarthrosis; Humans; Middle Aged; Thromboembolism; Thrombophilia; Warfarin

We report here the case of a 18-year-old young man with Behçet's disease who had suffered deep venous thrombosis of the right femoral and popliteal veins. Consequently, right sciatic nerve injury, drop foot and tightness of the achilles tendon also ensued. The clinical scenario was further challenged by demonstration of the agenetic inferior vena cava and epidural vein dilatations compressing the lumbar nerve roots. To the best notice of the authors, this is the first patient encompassing all these complications in the literature concerning Behçet's disease.

Topics: Adolescent; Amines; Behcet Syndrome; Colchicine; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Gabapentin; gamma-Aminobutyric Acid; Heparin; Humans; Injections, Intravenous; Interferons; Male; Nerve Compression Syndromes; Physical Therapy Modalities; Sciatic Nerve; Sciatica; Vena Cava, Inferior; Venous Thrombosis; Warfarin

The aim of this study was to compare the efficacy of immunosuppressive therapy alone with that of combination therapy involving immunosuppressants and anticoagulation for the treatment of venous thrombosis in Behcet's disease (BD). A retrospective analysis was made of 37 patients with venous thrombosis in BD. BD patients with venous thrombosis were divided into three groups: one group (N = 16) received immunosuppressive therapy alone, another group (N = 17) received immunosuppressant and anticoagulation combination therapy, and the third group (N = 4) received anticoagulation therapy only. Clinical and laboratory parameters and the recurrence of venous thrombosis were assessed. Venous thrombosis in BD appeared to have a more diffuse pattern than idiopathic type and a predilection for lower limbs. The most commonly involved sites were the superficial and common femoral veins. Recurrence of venous thrombosis occurred in two cases in the immunosuppressant group (12.5%), one case in the combination therapy group (5.9%), and three cases in the anticoagulant group (75%). No significant difference was found between recurrence in the immunosuppressant and combination therapy groups. Acute phase reactants were elevated in all six patients at the time of venous thrombosis recurrence. Our study suggests that immunosuppressive therapy is essential and that anticoagulation therapy might not be required for the treatment of deep venous thrombosis associated with BD.

Topics: Adrenal Cortex Hormones; Adult; Anticoagulants; Behcet Syndrome; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Retrospective Studies; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Behcet Syndrome; Diagnosis, Differential; Fever; Humans; Male; Myxoma; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Behçet's syndrome is a chronic multisystem disease that presents with recurrent oral and genital ulceration and recurrent uveitis. Cardiac involvement is an extremely rare manifestation of this disorder. A 33-year-old man with Behçet's syndrome was admitted to our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic and transesophageal echocardiography revealed a right ventricular thrombus. After 1 month of treatment with warfarin, cyclophosphamide, and corticosteroid, the intracardiac thrombus resolved.

Topics: Adult; Anticoagulants; Behcet Syndrome; Cyclophosphamide; Drug Therapy, Combination; Glucocorticoids; Heart Diseases; Heart Ventricles; Humans; Immunosuppressive Agents; Male; Methylprednisolone; Pulmonary Embolism; Recurrence; Thrombophlebitis; Thrombosis; Ultrasonography; Warfarin

Pulmonary manifestations of Behcet's disease are not very common and usually include pulmonary artery aneurysms, central venous thrombosis, pneumonia and pleurisy. Chylothorax secondary to superior vena caval obstruction is a rare complication and has been reported in only a few cases. We report a case of a 24-year-old man presenting with massive chylothorax as the initial presentation of Behcet's disease that was successfully treated conservatively.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Chylothorax; Diagnosis, Differential; Humans; Male; Pleural Effusion; Prednisolone; Superior Vena Cava Syndrome; Warfarin

We report a case of a 53-year-old man with Behcet's disease (BD) and paradoxical stroke. This patient suddenly developed sensory aphasia, right oculomotor palsy, nystagmus, and left ataxic hemiparesis. MR images showed fresh embolic infarcts in the midbrain and the left parietotemporal lobe. He presented with uveitis, oral aphthous ulcers and genital ulcers. An electrocardiogram revealed no abnormalities, and a transesophageal echocardiogram disclosed a patent foramen ovale. Since venous involvement is common in BD, we suspected the presence of smaller thrombi probable in this patient. We conclude that embolic stroke is a notable complication of BD with right-to-left shunting.

Topics: Anticoagulants; Behcet Syndrome; Echocardiography, Transesophageal; Follow-Up Studies; Heart Septal Defects, Atrial; Humans; Intracranial Embolism; Magnetic Resonance Imaging; Male; Mesencephalon; Middle Aged; Parietal Lobe; Temporal Lobe; Warfarin

Topics: Adult; Behcet Syndrome; Colchicine; Drug Therapy, Combination; Female; Humans; Plasma Exchange; Prednisone; Purpura, Thrombotic Thrombocytopenic; Treatment Outcome; Warfarin

Cutaneous polyarteritis-nodosa-like lesions are rarely described in Behcet's disease. We report a case of recurrent cutaneous polyarteritis-nodosa-like (C-PAN-like) lesions in Behcet's disease with multiple deep vein thromboses as part of systemic vasculitis. The mucocutaneous manifestations responded to prednisolone; however, C-PAN-like lesions were refractory and responded to oral cyclosporine. We conclude that C-PAN-like lesions may be marker of severe disease and require intense immunosuppressive therapy.

Topics: Adolescent; Anticoagulants; Azathioprine; Behcet Syndrome; Colchicine; Cyclosporine; Heparin; Humans; Immunosuppressive Agents; Male; Methotrexate; Polyarteritis Nodosa; Prednisone; Thrombophlebitis; Warfarin

Behçet's disease (BD) is a chronic relapsing systemic vasculitis in which orogenital ulceration is a prominent feature. The disease affects many systems and causes hypercoagulability. We present a 27-year-old male patient who exhibited widespread great vessel thrombosis including right atrial and ventricular thrombi in the setting of right-sided infectious endocarditis and orogenital aphthous ulcerations and erythema nodosum due to BD. We reviewed the enigmatic prothrombotic state of BD, and discuss our prior experiences in this field.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Axillary Vein; Behcet Syndrome; Drug Therapy, Combination; Endocarditis, Bacterial; Endothelium, Vascular; Erythema Nodosum; Heart Atria; Heart Diseases; Heart Ventricles; Heparin; Humans; Male; Pulmonary Veins; Stomatitis, Aphthous; Streptokinase; Superior Vena Cava Syndrome; Thrombectomy; Thrombolytic Therapy; Thrombophilia; Thrombosis; Tissue Plasminogen Activator; Tricuspid Valve; Venous Thrombosis; Warfarin

Behçet's disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A case of a 33 year old man with Behçet's disease, presenting with a large right ventricle and right atrial thrombus, is reported. Two dimensional (cross sectional), colour Doppler, and transoesophageal echocardiography, angiography, computed tomography, and magnetic resonance imaging were used to diagnose the disease. With cyclophosphamide and dexamethasone treatment, the cardiac lesions progressively resolved.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Colchicine; Cyclophosphamide; Dexamethasone; Drug Therapy, Combination; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Heart Atria; Heart Diseases; Heart Ventricles; Humans; Immunosuppressive Agents; Male; Thrombosis; Warfarin

Behçet's disease frequently involves the venous system, usually affecting small vessels, but sometimes large vessels such as the vena cava. Antiphospholipid antibody syndrome is associated with an increased incidence of arterial and venous thrombosis. A 29-year-old male with Behçet's disease developed bilateral leg edema secondary to thrombotic occlusion of the inferior vena cava. Laboratory tests revealed positive antiphospholipid antibodies and lupus anticoagulant. Treatment with steroid and warfarin subsequent to intravenous administration of uro-kinase resulted in improvement of symptoms. The association of antiphospholipid antibody syndrome and Behçet's disease may have caused the total thrombotic occlusion of the vena cava in this case.

Topics: Adult; Antiphospholipid Syndrome; Behcet Syndrome; Edema; Humans; Male; Prednisolone; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Behçet's disease is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Cardiac involvement is an extremely rare manifestation of this disorder. We report an unusual case of Behçet's disease characterized by a mural cardiac thrombi in the right atrium and right ventricle along with transient protein C and S deficiency.

Topics: Adult; Atrial Function, Right; Behcet Syndrome; Echocardiography; Heart Diseases; Humans; Immunosuppressive Agents; Male; Protein C Deficiency; Protein S Deficiency; Thrombosis; Ventricular Dysfunction, Right; Warfarin

Right ventricular thrombus is a very rare manifestation of cardiovascular Behcet's disease. A 25-year-old man was admitted to hospital due to cough and fever of unknown origin. He experienced repetitive pulmonary embolism due to a right ventricular thrombus, which was surgically removed. A diagnosis of Behcet's disease was made based on his clinical course and the histological findings of the right ventricular wall and the skin lesion. He was quickly relieved of his symptoms after warfarinization and cyclosporine therapy.

Topics: Adult; Behcet Syndrome; Coronary Thrombosis; Cyclosporine; Diagnosis, Differential; Humans; Male; Paresis; Pulmonary Embolism; Ventricular Dysfunction, Right; Warfarin

A 20 year-old Turkish patient presented with superior sagittal and lateral sinus thrombosis. The frequency of cerebral venous thrombosis generally is underestimated and may be the first clinical manifestation. In case of intracranial hypertension, cerebral venous thrombosis and Behcet's disease should be taken into consideration, especially in the high risk population from Eastern Mediterranean countries and Japan. CT with enhancement and MRI study with T1- and T2- weighted images were used to detect the thrombosed veins and to evaluate the thrombosis. Treatment with anticoagulation and corticosteroid therapy in cerebral venous thrombosis is well established today. Clinical course and prognosis in cerebral venous thrombosis are generally benign if adequate management is started in time.

Topics: Adult; Behcet Syndrome; Dexamethasone; Drug Therapy, Combination; Heparin; Humans; Intracranial Embolism and Thrombosis; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Warfarin

Topics: Behcet Syndrome; Drug Therapy; Humans; Pathology; Radiography; Steroids; Thrombosis; Venae Cavae; Venous Thrombosis; Warfarin