A Case of HLA-B51 Positive Mucocutaneous Variant of Behçet’s Disease in a Young Indian Male: A Case Report
DOI:
https://doi.org/10.38179/ijcr.v2i1.70Keywords:
Behcet's Disease, Behcet Syndrome, Colchicine, Aphthous Ulcer , Diagnosis, HLA-B51, India, Case ReportAbstract
Background: Behçet’s disease is a rare, systemic inflammatory disorder of unknown etiology affecting the mucocutaneous, vascular, skeletal, ophthalmic, gastrointestinal, and neurological systems. While the exact etiopathogenesis of Behçet’s disease is yet to be established, numerous studies have supported a strong possibility of underlying genetic factors. It is comparatively more common in Turkey, the Middle East, and Mediterranean regions, and only a few cases have been reported from the Indian subcontinent so far. Although several immunological and genetic associations have been suggested, the diagnosis of Behçet’s disease remains primarily clinical and of exclusion.
Case Report: In this report, we describe the case of a 22-year-old Indian male who developed multiple aphthous ulcers over his tonsillar pillars and pharyngeal wall following an episode of acute tonsillopharyngitis. Over the course of the next few days, he reported the presence of a genital ulcer and papulopustular lesions over his chest, back and face, eventually prompting a diagnosis of Behçet’s disease. He was treated with oral colchicine and was found to be in remission during a six-week follow-up.
Conclusion: This case emphasizes the importance of awareness regarding Behçet’s disease among clinicians in India and warrants further studies on the epidemiology, immunopathogenesis, and management protocols of Behçet’s disease, especially in this country for a better understanding of its prevalence, manifestations, and disease course.
References
Zouboulis CC, Vaiopoulos G, Marcomichelakis N, et al. Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece. Clin Exp Rheumatol. 2003;21(4 Suppl 30):S19-S26. PMID: 14727454
Behcet, H. UBER REZIDIVERENDE APHTHOSE DURCH EIN VIRUS VERURSACHTE GESCHWURE AM MUND, AM AUGE UND AN DEN GENITALIEN. Dermatol Wocherschr, 1937(105:1152–1157.
Keino H, Okada AA. Behçet's disease: global epidemiology of an Old Silk Road disease. Br J Ophthalmol. 2007;91(12):1573-1574. PMID: 18024803. https://doi.org/10.1136/bjo.2007.124875
Calamia KT, Wilson FC, Icen M, Crowson CS, Gabriel SE, Kremers HM. Epidemiology and clinical characteristics of Behçet's disease in the US: a population-based study. Arthritis Rheum. 2009;61(5):600-604. PMID: 19405011. https://doi.org/10.1002/art.24423
Singal A, Chhabra N, Pandhi D, Rohatgi J. Behçet's disease in India: a dermatological perspective. Indian J Dermatol Venereol Leprol. 2013;79(2):199-204. PMID: 23442458. https://doi.org/10.4103/0378-6323.107636
Sachdev N, Kapali N, Singh R, Gupta V, Gupta A. Spectrum of Behçet's disease in the Indian population. Int Ophthalmol. 2009;29(6):495-501. PMID: 18936879. https://doi.org/10.1007/s10792-008-9273-8
Fietta P. Behçet's disease: familial clustering and immunogenetics. Clin Exp Rheumatol. 2005;23(4 Suppl 38):S96-S105. PMID: 16273774.
Burillo-Sanz S, Montes-Cano MA, García-Lozano JR, et al. Behçet's disease and genetic interactions between HLA-B*51 and variants in genes of autoinflammatory syndromes. Sci Rep. 2019;9(1):2777. Published 2019 Feb 26. PMID: 30808881. https://doi.org/10.1038/s41598-019-39113-5
Salmaninejad A, Zamani MR, Shabgah AG, et al. Behçet's disease: An immunogenetic perspective. J Cell Physiol. 2019;234(6):8055-8074. PMID: 30341905. https://doi.org/10.1002/jcp.27576
Emmi G, Silvestri E, Squatrito D, et al. Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J. 2015;13:15. Published 2015 Apr 16. PMID: 25883536. https://doi.org/10.1186/s12959-015-0047-z
Saadoun D, Wechsler B. Behçet's disease. Orphanet J Rare Dis. 2012;7:20. Published 2012 Apr 12. PMID: 22497990. https://doi.org/10.1186/1750-1172-7-20
Atzeni F, Sarzi-Puttini P, Doria A, Boiardi L, Pipitone N, Salvarani C. Behçet's disease and cardiovascular involvement. Lupus. 2005;14(9):723-726. PMID: 16218475. https://doi.org/10.1191/0961203305lu2208oa
McGonagle D, Aydin SZ, Gül A, Mahr A, Direskeneli H. 'MHC-I-opathy'-unified concept for spondyloarthritis and Behçet disease. Nat Rev Rheumatol. 2015;11(12):731-740. PMID: 26526644. https://doi.org/10.1038/nrrheum.2015.147
Ahn JK, Park YG. Human leukocyte antigen B27 and B51 double-positive Behçet uveitis. Arch Ophthalmol. 2007;125(10):1375-1380. PMID: 17923546. https://doi.org/10.1001/archopht.125.10.1375
Maldini C, Lavalley MP, Cheminant M, de Menthon M, Mahr A. Relationships of HLA-B51 or B5 genotype with Behcet's disease clinical characteristics: systematic review and meta-analyses of observational studies. Rheumatology (Oxford). 2012;51(5):887-900. PMID: 22240504. https://doi.org/10.1093/rheumatology/ker428
Direskeneli H. Behçet's disease: infectious aetiology, new autoantigens, and HLA-B51. Ann Rheum Dis. 2001;60(11):996-1002. PMID: 11602462. https://doi.org/10.1136/ard.60.11.996
International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014;28(3):338-347. PMID: 23441863. https://doi.org/10.1111/jdv.12107
Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet. 1990;335(8697):1078-1080. PMID: 1970380.
Alpsoy E, Zouboulis CC, Ehrlich GE. Mucocutaneous lesions of Behcet's disease. Yonsei Med J. 2007;48(4):573-585. PMID: 17722228. https://doi.org/10.3349/ymj.2007.48.4.573
Ambrose NL, Haskard DO. Differential diagnosis and management of Behçet syndrome. Nat Rev Rheumatol. 2013;9(2):79-89. PMID: 23007742. https://doi.org/10.1038/nrrheum.2012.156
Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol. 2018;79(6):987-1006. PMID: 29653210. https://doi.org/10.1016/j.jaad.2017.11.064
Kaklamani VG, Kaklamanis PG. Treatment of Behçet's disease--an update [published correction appears in Semin Arthritis Rheum 2001 Aug;31(1):69]. Semin Arthritis Rheum. 2001;30(5):299-312. PMID: 11303303. https://doi.org/10.1053/sarh.2001.19819
Nakamura K, Iwata Y, Asai J, et al. Guidelines for the treatment of skin and mucosal lesions in Behçet's disease: A secondary publication. J Dermatol. 2020;47(3):223-235. PMID: 31907947. https://doi.org/10.1111/1346-8138.15207
Davatchi F, Sadeghi Abdollahi B, Tehrani Banihashemi A, et al. Colchicine versus placebo in Behçet's disease: randomized, double-blind, controlled crossover trial. Mod Rheumatol. 2009;19(5):542-549. PMID: 19597921. https://doi.org/10.1007/s10165-009-0200-2
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