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Título

Case Report: Acute Ischemic Stroke in Behçet's Disease

RESUMO

Case presentation: A 16-year-old male patient, previously healthy, presented a sudden onset of severe headache associated with paresis of the right hemibody. Undergoing hospitalization in a highly complex local referral hospital for treatment and investigation. During the hospital stay, he develops a new condition of left hemiparesis, suddenly. In both events, areas of cerebral ischemia were evidenced, confirmed by magnetic resonance imaging, in different locations. After active investigation, patient and mother confirmed a personal history of recurrent oral ulcers, episodes of ulcers in the penile region, and ulcerated skin lesions.
Complementary exams: Skull Resonance: Temporo-parietal signal alteration on the right represented by hypersignal on T2 and FLAIR which may correspond to an ischemic event. Entry labs exams (2/16/2022): ESR 150, Bilirubin 2.4, TGO 38, TGP 51, Reticulocytes 2.5%, DHL 519. Pathergy test was positive. Patient submitted to hospital pulse therapy treatment with 1g/day of Methylprednisolone for five days, associated with full anticoagulation, evolving with stability of the condition. Patient referred for outpatient follow-up after hospital discharge, with oral corticosteroid maintenance, therapeutic anticoagulation and immunosuppressive therapy planning.
Discussion: Behçet's Disease is an autoimmune syndrome, and among the systemic vascular diseases, is notable for its ability to involve blood vessels of all sizes. Affects young adults aged 20 to 40 years and the most common clinical features are the presence of recurrent and painful mucocutaneous ulcers, painful urogenital lesions and various skin lesions. The neurological impairment of the syndrome occurs in less than 10% of patients and more commonly seen in men and the diagnosis is made on the basis of clinical findings. The goal of treatment is to promptly suppress inflammatory exacerbations and recurrences to avoid irreversible organ damage, and immunosuppressive medications are mainly indicated.
Final considerations: Despite being rare, the neurological impairment in Behçet syndrome has high rates of morbidity and mortality, given the vast clinical involvement of this pathology. Considering that the diagnosis of the disease is clinical, a careful anamnesis and the direct search for complications caused by this disease are essential for the treatment to be established and the systemic damage to be stopped.

Palavras Chave

Behçet's Disease, Acute Ischemic Stroke, autoimmune, ulcers