Behçet’s Disease and Tuberculosis: A Complex Relationship

Abstract

Behçet’s disease (BD) is a systemic vasculitis characterized by recurrent orogenital ulceration and several systemic manifestations (such as gastrointestinal involvement, vascular disease or arthritis). The pathogenesis is still unknown but the trigger role of certain pathogens such as Mycobacterium tuberculosis is well documented. Furthermore, patients with BD are more susceptible to tuberculosis due to immunity defects. Here, we describe the case of a 70-year-old woman with a history of recurrent oral aphthae and inflammatory arthritis presenting with extensive thrombosis of left upper limb major veins, a positive HLA B51 genotype and colon ulceration; hence, BD diagnosis was made after excluding other causes. Simultaneously, the patient had cutaneous abscesses not associated with immunosuppressive therapy with continuous development, and after recurrent negative tuberculosis work-up, M. tuberculosis was isolated in an abscess culture.

Prevalence and risk factors of active tuberculosis in patients with rheumatic diseases: a multi-center, cross-sectional study in China

“…The independent risk factors for ATB included BD and SLE. BD itself may produce a defect in cell-mediated immunity, which increased the risk of developing ATB [ 26 , 27 ]. Additionally, TB infection may also be involved in inducing BD in individuals with genetic susceptibility [ 28 ].…”

Persistent infection of Mycobacterium tuberculosis in a patient with Behçet’s disease after rotator cuff repair surgery: A case report

“…[ 8 ] Mycobacterium tuberculosis is known to trigger Behçet's disease. [ 9 ] Moreover, the incidence of TB infection in Behçet's disease sufferers increases significantly, due to both cell-mediated immune system disorders observed in these patients, and the medications used in the treatment of this disease that suppress the immune system, in particular, anti- TNF agents. [ 8 ] Consequently, TB infection in Behçet's disease sufferers can be both the cause and the result.…”

Neuro-Behçet’s Disease Onset in the Context of Tuberculous Meningoencephalitis: A Case Report

“…Oral ulcers in TB are rare, affecting under 1% of patients, but their incidence seems to be on the rise [35]. The difference between TB pseudo-Behçet's disease and BD is the clinical response to treatment, with symptoms remitting completely under tuberculostatic treatment in the first case and needing immunosuppressive therapy in the second [9,29].…”

“…The relationship between Mycobacterium tuberculosis (MT) and BD is complex and not entirely clarified. On the one hand, the cell-mediated immunity defects produced by BD increase a patient's susceptibility to tuberculosis (TB); on the other hand, TB seems to increase the risk and severity of BD [8,9].…”