J Korean Rheum Assoc.  2007 Mar;14(1):96-100. 10.4078/jkra.2007.14.1.96.

Recurrent Acute Myocardial Infarctions and Budd-Chiari Syndrome in Young Woman with Behcet's Disease

• Chang MH
• Bang SY
• Kim TH
• Jun JB
• Yoo DH
• Bae SC
• Uhm WS

• KMID: 2202197
• DOI: http://doi.org/10.4078/jkra.2007.14.1.96

Abstract

We report here a case of vascular Behcet's disease. 32-year-old young woman who suffered from chest pain was diagnosed with acute myocardial infarction four years before admission. At that time she manifested symtoms of Behcet's disease, such as oral ulcers, genital ulcers, multiple arthralgia, and a peculiar hyperirritability reaction to needle puncture. At this time she was admitted due to acute chest pain and intermittent abdominal pain. The diagnosis of an acute anteroseptal myocardial infarction was made on the basis of the electrocardiography findings. Cardiac catheterization revealed segmental stenosis up to 95% at the mid-left anterior descending artery without aneurysm formation at other coronary trees and there were no atherosclerotic changes. Coronary stent was inserted in the lesion. Abdominal CT showed inferior vena cava and right hepatic vein obstruction, which supports the diagnosis of Budd-Chiari syndrome. Our case demonstrated the followings which are not common to vasculo-Behcet disease; 1) initial clinicopathologic manifestations at the coronary artery, 2) abrupt total occlusion with clear cut lesion at left anterior descending artery, 3) recurrent myocardial infarctions, 4) Budd-Chiari syndrome, 5) combined superior mesenteric artery, inferior mesenteric artery and celiac trunk obstruction. Among the systemic manifestation of Behect's disease, cardiac involvement is very rare but should be considered as one of the most important features that influences the prognosis.

Keyword

Behcet's disease; Acute myocardial infarction; Budd-Chiari syndrome

MeSH Terms

Abdominal Pain
Adult
Aneurysm
Anterior Wall Myocardial Infarction
Arteries
Arthralgia
Budd-Chiari Syndrome*
Cardiac Catheterization
Cardiac Catheters
Chest Pain
Constriction, Pathologic
Coronary Vessels
Diagnosis
Electrocardiography
Female
Heart Diseases
Hepatic Veins
Humans
Mesenteric Artery, Inferior
Mesenteric Artery, Superior
Myocardial Infarction*
Needles
Oral Ulcer
Prognosis
Punctures
Stents
Tomography, X-Ray Computed
Ulcer
Vena Cava, Inferior

Figure

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  Fig. 1. Right coronary artery was obstructed similar to 4-year ago.

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  Fig. 2. (A) Coronary angiography of the left anterior descending artery. Total obstruction in mid left anterior descending artery before percutaneous coronary intervention was observed. (B) After percutaneous coronary intervention, successful reperfusion was obtained without residual stenosis.

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  Fig. 3. Longitudinal filling defect was noted in portal phase coronal scan of abdominal CT, suggesting intra- luminal thrombosis of intrahepatic inferior vena cava.

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