Pleural Effusion Presenting in a Young Man With Behcet’s Disease

Abstract

Behcet's disease (BD) is a rare multisystem chronic vasculitis of variable clinical presentation and unknown origin. Pulmonary involvement in BD is uncommon, with pleural effusion being an even rarer and difficult to diagnose manifestation. Herein, we report a challenging case of a young man who presented with recurrent pleural effusion and hepatic vein thrombosis and a recent history of papilledema with idiopathic intracranial hypertension. The patient was hospitalized for diagnostic and therapeutic thoracocentesis. Biochemistry and cytological analysis showed an exudative aspect of the collected pleural fluid with lymphocyte-dominated cytology. A multidisciplinary discussion was held, and thorough investigation was carried out to rule out malignant and infectious etiologies, among other differentials. During the second hospitalization, the patient complained of genital ulcers, which were verified to be recurrent along with oral ulcers. The diagnosis of BD was established based on the International Classification Criteria for BD, and the symptoms improved significantly upon using colchicine and immune-suppressive drugs.

Behçet’s Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement

“…Pleural vasculitis can lead to the formation of pleural nodules, which may appear as parenchymal subpleural lesions. Pleural effusion as a manifestation of BD is rare and is due to SVC thrombosis or pulmonary infarction in most cases [ 35 , 83 ]. Chylothorax, chylopericardium, and ascites can occur as a complication of SVC syndrome in BD [ 84 ].…”

Pleural Diseases in Connective Tissue Diseases

“…There have been six case studies of central venous obstruction leading to pleural effusion in the literature. [95][96][97][98][99][100] These are predominantly exudative lymphocytic chylothoraces [95][96][97] with two instances of transudates. 98,99 Although treatment has not been well established, recurrent pleural effusion has shown a good response to a combination of oral corticosteroid, immunosuppression and pleurodesis-either mechanical 97 or pharmacological using tetracycline 95 or talc.…”