Tuberc Respir Dis.  2006 Jul;61(1):65-69.

A Case of Behcet's Disease with Multiple Cavitary Lung Lesion

• Yoon SH
• Son JW
• Joung CI
• Choi EG

Abstract

Behcet's disease is a systemic vasculitis of an unknown etiology involving the arteries and veins of all sizes. There are reports showing that a pulmonary artery aneurysm or thromboembolism and superior vena cava thrombosis are present in 5-10% of patients with Behcet's disease and that lung parenchymal lesions are mainly airway consolidations resulting from hemorrhage or infarction. We encountered a patient with increasing pulmonary cavitary changes and localized aspergilloma. The patient was a 43-year-old man diagnosed with Behcet's disease with a history of recurrent oro-genital ulceration and uveitis, and who was administered methotrexate, colchicines, prednisolone. During the follow up he developed progressive dyspnea upon exertion and finger clubbing. Therefore further evaluations were performed. Chest computed tomography showed more advanced consolidations and cavitations than the previous film with the previously known aspergilloma still observable. An open lung biopsy was carried out to determine the presence of malignant changes, which revealed nonspecific vasculitis. Azathioprine was added resultion in an improvement of symptoms.

Keyword

Behcet's disease; Cavitary lung lesion; Aspergilloma

MeSH Terms

Adult
Aneurysm
Arteries
Azathioprine
Biopsy
Dyspnea
Fingers
Follow-Up Studies
Hemorrhage
Humans
Infarction
Lung*
Methotrexate
Prednisolone
Pulmonary Artery
Superior Vena Cava Syndrome
Systemic Vasculitis
Thorax
Thromboembolism
Ulcer
Uveitis
Vasculitis
Veins
Azathioprine
Methotrexate
Prednisolone

Figure

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  Figure 1 On chest radiography A, there is cavitary consolidative mass-like lesion at left upper lung field. On chest radiography B, there is more increased size of cystic lesion with air fluid level in both upper lung field and newly developed cystic lesion in right lower lung field and increased ill defined haziness in lower lung field

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  Figure 2 At initial chest CT (A) shows multifocal consolidation with ground glass haziness and some cavitary change in subpleural area of both lung. After 16 months chest CT (B) shows newly developed cavitary lesion is at both lower lung field and the cavity of left lower lung field was more greater than before. The small mass like lesion is in the center of cavity on left lower lobe. It is suggesting aspergilloma. A: 2003/10/17 chest CT, B: 2005/01/20 chest CT

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  Figure 3 Histologic findings of open lung biopsy. These microscopic findings show interstitial inflammation, diffuse alveloar hemorrhage and vasculitis (A)(B)(C). and mass like lesion in the cavity reveals the septated hyphae(D) (H&E, ×100,A and B) (H&E, ×400, C) (GMS, ×200, D).

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