A cas e of B ehcet' s bis eas e w ith pulmonary inf arction

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1 : , *, = A bs tra c t= A cas e of B ehcet' s bis eas e w ith pulmonary inf arction Yangjin Jegal, M.D., Hyunkyu Chang, M.D., Daesik Ryu, M.D*. and Kyoungsook Won, M.D. Department of Internal M edicine, Department of Diagnostic Radiology*, Departm ent of N uclear M edicine, K angnung Hospital, K angnung, Korea Behcet' s disease is a nonspecific vasculitis characterized by exacerbations and remissions of unpredictictable duration. The commom clinical features in most patients are orogenital ulcers, uveitis and skin lesions- especially erythema nodosum- like lesions or positive pathergy test. Among the systemic manifestations of Behcet' s disease, pulmonary involvement is very rare and only a few cases have been documented. T he main event of pulmonary involvement is vasculitis forming multilocular aneurysms and thrombosis of the pulmonary artery. T he commom pulmonary manifestations are hemoptysis, dyspnea, pleuritic chest pain, cough and fever. The prognosis of pulmonary vasculitis is very poor. A 30- year- old male patient with Behcet' s disease presented with fever and dyspnea for 10 days. In the past years, his vision of the left eye was lost due to chorioretinitis. He took right hemicolectomy because of the perforation of colonic ulcer. Also he has been suffered from left hemiparesis due to multiple cerebral infarction. We describe a case with Behcet's disease with pulmonary infarction improved with prednisolone and cyclosporine.(korean J Med 59: , 2000) Key Words : Behcet's syndrom; Pulmonary embolism; Vasculitis : ,,,,,,, % 7-35% 1, 4). 5% 1, 4, 5),,,,,, 2, 5, 6,).,. : :, 415, ( ) E- mail ; hanks@knh.co.kr,

2 Korean Journal of Medicine : Vol. 59, No. 5, :,, 30 : 10 : 5,, 3(choriorertinitis), 26 3 azathioprinevalproic acid 10., :,. : 120/80 mmhg, 105 /, 20 / 39.5.,,,,..,.,.,. : 12.4 g/dl, 15100/mm3, 258,000/mm3, 39 mm/hr,. AST/ALT 18/22 IU/L, 0.4 mg/dl, alkaline phosphatase 145 IU/L, /6.2/3.2 mg/dl, BUN/Cr 12.4/1.1 mg/dl, CRP 11.6 mg/dl. IgG cardiolipin, IgM cardiolipin 11.3 U MPL/mL,,, /mm3, 3130/mm3(65%, 10%, 22%, 2%, 1%), ph7.5, 171 mg/dl, 4.8 g/dl, LDH 1076 IU/L.,,.. : (consolidation) (Figure 1),, (Figure 2).. / : Figure 1. Chest radiography shows peripheral air- space consolidation in right lower lung (arrow) with pleural effusion. Figure 2. High resolution computerized tomography shows multifocal air- space consolidation (large arrow) in subpleural area of both lower lungs with right pleural effusion (small arrow). There are pleura-based triangulary shaped densities with apices directed toward hila suggesting multiple infarcts

3 Yangjin Jegal, et al : A case of Behcet' s bisease with pulmonary infarction Fig rue 3. Tc- 99m MAA perfusion lung scan : T here are multiple linear and wedge defects in the both lower lobes and right middle lobe. Figrue 4. Tc- 99m DTPA aerosol inhalation lung scan : T here are several defects in the right lower lobe which are mismatched with perfusion lung scan, but the inhalation of the right middle lobe is normal and a small subpleural inhalation defect is noted in the left lower lobe. T hese findings suggest pulmonary thromboembolism in the both lungs with pulmonary infarction of the right lower lobe. (Figrue 3), (Figure 4). :,.,,. cyclosporine 250 mg/day, prednisolone 40 mg/, colchicine 1.2 mg/ prednisolone 10 mg, colchicine. prednisolone 5 mg/, cyclosporine 250 mg/, 2,,.,,,. 30 (),.,,,,

4 : ,,, 3, 7).,,,,, 7-35% 8, 9), % 5, 10).. 11, 12)., 5, 6).,.. tissue plasminogen, cardiolipin 13). IgG cardiolipin, IgMcardiolipin., 3.6 4, 9, 10).,,,, 5, 6).,,,,,.,,,,. 90%,,,,,, 5, 6).,,, 7), 14-17).,.,, 6).,., 5,6, 10). 1, 13) 5,10, 14). prednisolone cyclosporine,., 30, prednisolone cyclosporine. RE F E R E N C E S 1),,,,,,,. Behcet. 38: , ),,,,,,,. Behcet 1. 36: , ) Ahn JM, Im JG, Ryoo JW, Kim SJ, Do YS, Choi YW, Oh YW, Yoen KM, Han MC. T horacic m anifestations of Behcet's syndrome: radiographic and CT findings in nine patients. Radiology 194: , ) Yazici H, Yurdakul S, Hamuryuden V. Behcet's syndrome. In: Klippel JH, Dieppe PA, eds. Rheuma

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