A brain mass in a patient with Behcet's disease: a case report
Affiliations
Affiliations
- Al-Adan Hospital, Hadiya, Kuwait. dr.alfedaghi@hotmail.com.
- Al-Adan Hospital, Hadiya, Kuwait.
- Al-Adan Hospital, Hadiya, Kuwait. mmourou@gmail.com.
Abstract
Introduction: This case report describes an uncommon presentation of Behcet's disease which manifested as neuro-Behcet's disease. Although it is not the first reported case in the medical literature, it is a possible differential in a patient presenting with a brain tumor. Since the diagnosis of neuro-Behcet's disease depends largely on the clinical picture and medical history, it should be considered prior to opting for invasive diagnostic methods.
Case presentation: Our patient is a 36-year-old white man from Kuwait. He presented with acute onset of headache, vomiting, and right-sided weakness. Magnetic resonance imaging of his brain showed a mass in the brain stem. He then revealed that he had a history of recurrent painful oral and genital ulcers for the past 10 years, which suggested a diagnosis of Behcet's disease. A brain biopsy was recommended by a neurosurgeon at the time, but the patient refused the procedure. After initiating steroid therapy, the mass began to regress and, eventually, was undetectable on subsequent imaging of his brain.
Conclusions: This case of neuro-Behcet's disease reflects the need to consider this diagnosis in a patient of less than 40 years of age presenting with a suspected brain tumor. This may delay the need for invasive diagnostic methods, especially if such methods are not desired by the patient. In the management of suspected neuro-Behcet's disease, initiating steroid therapy and measuring the response is a reasonable option before seeking a definitive diagnosis via brain biopsy. If the response to steroids is minimal then a brain biopsy should be performed.
Similar articles
Ferreira BFA, Rodriguez EEC, Prado LLD, Gonçalves CR, Hirata CE, Yamamoto JH.J Med Case Rep. 2017 Apr 15;11(1):104. doi: 10.1186/s13256-017-1261-z.PMID: 28410605 Free PMC article. Review.
[Pseudo-tumoral neuro-Behçet's disease].
Darmoul M, Habib Bouhaouala M, Smida H, Hedi Dougui M.Rev Neurol (Paris). 2006 May;162(5):643-7. doi: 10.1016/s0035-3787(06)75060-3.PMID: 16710132 French.
Magnetic resonance imaging findings and outcome of neuro-Behçet's disease: the predictive factors.
Farahangiz S, Sarhadi S, Safari A, Borhani-Haghighi A.Int J Rheum Dis. 2012 Dec;15(6):e142-9. doi: 10.1111/1756-185X.12013. Epub 2012 Oct 27.PMID: 23253242
Neuro-Behçet's disease manifesting as a neoplasm-like lesion--case report.
Imoto H, Nishizaki T, Nogami K, Sakamoto K, Nomura S, Akimura T, Matsunaga T, Suzuki M.Neurol Med Chir (Tokyo). 2002 Sep;42(9):406-9. doi: 10.2176/nmc.42.406.PMID: 12371599
Yeo M, Lee HL, Cha M, Kim JS, Han HS, Lee SH, Lee SS, Shin DI.J Med Case Rep. 2016 Dec 20;10(1):360. doi: 10.1186/s13256-016-1151-9.PMID: 27998307 Free PMC article. Review.
Cited by
[Pseudo-tumor form of neuro-Behçet disease: case study and literature review].
Guini M, Khoulali M, Raouzi N, Ouali N, Moufid F.Pan Afr Med J. 2019 Jul 12;33:194. doi: 10.11604/pamj.2019.33.194.18719. eCollection 2019.PMID: 31692738 Free PMC article. Review. French.
References
-
- Alnaimat F. Behcet disease. http://emedicine.medscape.com/article/329099-overview (16 December 2014). Accessed 17 April 2015.