Korean Circ J.  2011 Jul;41(7):399-401. 10.4070/kcj.2011.41.7.399.

Aseptic Endocarditis in Behcet's Disease Presenting as Tricuspid Valve Stenosis

• Lee HS
• Choi WS
• Kim KH
• Kang JK
• Kim NY
• Park SH
• Park Y
• Nam EJ
• Yang DH
• Park HS
• Cho Y
• Lee JM
• Chae SC

• KMID: 2225104
• DOI: http://doi.org/10.4070/kcj.2011.41.7.399

Abstract

Aseptic endocarditis is an uncommon complication of Behcet's disease (BD). We describe a rare case of a 39-year-old female who had BD with aseptic endocarditis of the tricuspid valve (TV) presenting as tricuspid stenosis. She was diagnosed with BD four years ago. The mucocutaneous lesions were well-controlled with colchicine and short courses of corticosteroids. She remained free of signs and symptoms of BD for one year without any medication. Three months before admission, she gradually developed dyspnea on exertion and peripheral edema. Echocardiography revealed dilated right atrium and markedly thickened TV with severe stenosis. TV replacement was performed. Pathologic examination of the valve showed fibrinoid necrotic material and inflammatory cell infiltration. Blood cultures and cultures of the excised valve were negative for microorganisms.

Keyword

Behcet syndrome; Endocarditis; Tricuspid valve stenosis

MeSH Terms

Adrenal Cortex Hormones
Adult
Behcet Syndrome
Colchicine
Constriction, Pathologic
Dyspnea
Echocardiography
Edema
Endocarditis
Female
Heart Atria
Humans
Tricuspid Valve
Tricuspid Valve Stenosis
Adrenal Cortex Hormones
Colchicine

Figure

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  Fig. 1 Transesophageal echocardiography showed a dilated right atrium and a thickened and doming tricuspid valve with an ill-margined echogenic mass (2.1×1.6 cm in size) between the septal and posterior leaflet, and a mild to moderate amount of pericardial effusion.

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  Fig. 2 Peak velocity of the tricuspid inflow was 1.9 m/sec and the mean pressure gradient between the right atrium and right ventricle was estimated to be approximately 12.6 mmHg.

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  Fig. 3 A light microscopy showed endocarditis manifesting as valvulitis, consisting of fibrinoid necrotic material and inflammatory cells (hematoxylin and eosin staining; ×100).

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  Fig. 4 Inflammatory cells were predominantly the mononuclear cells. In some areas, aggregation of neutrophils was also seen. Small arteries and arterioles in the subintimal area showed irregular thickening of the wall that might be due to previous vasculitis arrow (hematoxylin and eosin staining; ×400).

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