Tuberc Respir Dis.  1996 Oct;43(5):763-773. 10.4046/trd.1996.43.5.763.

Clinical Manifestations of the Lung Involvement in Behet's Syndrome

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
  • 2Department of Radiology, College of Medicine, Yonsei University, Seoul, Korea.

Abstract

Background
Behet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behet's syndrome is a unique clinical feature, differing from other vascuitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behet's syndrome.
Methods
We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses.
Results
1) The incidence of the lung involvement in Behet's syndrome was 2%(10/487). The male to female ratio was 8: 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary arteries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis.
Conclusion
Pulmonary vasculitis is a main feature of the lung involvement of Behet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

Keyword

Behet's syndrome; Pulmonary vasculitis; Pulmonary artery aneurysm

MeSH Terms

Adrenal Cortex Hormones
Aneurysm
Angiography
Anticoagulants
Blood Vessels
Cause of Death
Central Nervous System
Colchicine
Cyclophosphamide
Female
Fistula
Hemoptysis
Hemorrhage
Humans
Incidence
Joints
Lung*
Male
Medical Records
Mucous Membrane
Pulmonary Artery
Pulmonary Embolism
Retrospective Studies
Sepsis
Skin
Thorax
Thromboembolism
Tomography, X-Ray Computed
Vasculitis
Adrenal Cortex Hormones
Anticoagulants
Colchicine
Cyclophosphamide
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