Sacroiliitis in Behçet syndrome.

Abstract

A33-year-old woman presented with inflammatory low back pain for 1 year, recurrent painful oral aphthous, and genital ulcers for 6 months with remaining tissue scarring, extensive pseudofolliculitis on the upper and lower limbs, fever, weight loss, and bilateral anterior uveitis. Seven months later, the patient presented bilateral panuveitis. She had no abdominal pain, diarrhea, anemia, or other symptoms that suggested inflammatory intestinal disease. Human leukocyte antigen B27 and antinuclear antibody tests were negative. The patient was diagnosed with Behçet disease according to the International Study Group criteria. Most symptoms were resolved with corticosteroid eye drops, oral corticosteroids, colchicine, and methotrexate, but the low back pain alleviated only with nonsteroidal antiinflammatory drugs. After 4 years of follow-up, there is no back pain or skin or eye disease on this treatment. Radiography has not been performed again. Radiography of the sacroiliac joints did not show abnormalities. After gadolinium administration, coronal T1-weighted magnetic resonance imaging of the sacroiliac joints demonstrated left joint space enhancement indicative of synovitis (Figure, arrows). Edema of the sacral surface of the adjacent sacroiliac joint (Figure, open arrow) and sclerosis of the iliac surface (Figure, asterisk) were also observed, indicating sacroiliitis. Behçet disease, a systemic vasculitis of unknown etiology, is characterized by relapsing episodes of oral and genital ulcers, skin lesions, and ophthalmological disease. It can also affect the vascular, gastrointestinal, and neurological systems. Rheumatic manifestations have been described in 45% of patients with Behçet syndrome, ranking second after skin and mucosal manifestations. Inflammatory arthralgia is the most common manifestation (81% of cases), and sacroiliitis is uncommon (7.5% of cases). Some authors have described a high prevalence of sacroiliitis in patients with Behçet disease, but others have found no association between these conditions. The main reason for these differing results could be a high degree of interobserver variation in interpreting radiographs of the sacroiliac joints. In our case, sacroiliitis was demonstrated by magnetic resonance imaging, the most sensitive method for the detection and early diagnosis of this condition. Joint involvement can be an early manifestation of Behçet syndrome, potentially causing significant disability.

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