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A brain mass in a patient with Behcet's disease: a case report.

Alfedaghi AS, Masters Y, Mourou M, Eshak O - J Med Case Rep (2015)

Bottom Line: 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.If the response to steroids is minimal then a brain biopsy should be performed.

View Article: PubMed Central - PubMed

Affiliation: Al-Adan Hospital, Hadiya, Kuwait. dr.alfedaghi@hotmail.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.

No MeSH data available.


Related in: MedlinePlus

Brain computed tomography (axial images). Left temporoparietal hypodensity extending into left cerebral peduncle with faint central hyperdensity with mass effect and midline shift of 5mm
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Fig1: Brain computed tomography (axial images). Left temporoparietal hypodensity extending into left cerebral peduncle with faint central hyperdensity with mass effect and midline shift of 5mm

Mentions: Laboratory testing which including a complete blood count, renal function test, liver function test, serum electrolyte, inflammatory markers such as erythrocyte sedimentation rate and C- reactive protein, viral serology, including human immunodeficiency virus (HIV), and blood cultures did not yield any abnormalities. An initial computed tomography (CT) of his brain showed an ill-defined left temporoparietal hypodensity with a faint central hyperdensity with mass effect and midline shift (Fig. 1). Due to the high suspicion of cerebral venous/arterial thrombosis, MRI of his brain as well as magnetic resonance venography (MRV) and magnetic resonance angiography (MRA) were performed. Imaging showed a mass involving his left thalamus, midbrain, and pons. The lesion resulted in mild fullness of the ipsilateral lateral ventricle due to compression of left foramen of Monro with midline shift (Fig. 2). MRV and MRA were unremarkable (Fig. 3). After reviewing his past medical history, he reported heavy cigarette smoking with recurrent episodes of painful mouth and genital ulcers which were treated with low-dose steroids for the last 10 years. His family history was unremarkable for chronic or inherited disease and there was no obvious precipitating factor for his current condition. After consulting the neurologist, the space-occupying lesion in his brain was suspected to be a brain tumor and a brain biopsy was advised; however, the patient refused and preferred medical treatment instead.Fig. 1


A brain mass in a patient with Behcet's disease: a case report.

Alfedaghi AS, Masters Y, Mourou M, Eshak O - J Med Case Rep (2015)

Brain computed tomography (axial images). Left temporoparietal hypodensity extending into left cerebral peduncle with faint central hyperdensity with mass effect and midline shift of 5mm
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4589116&req=5

Fig1: Brain computed tomography (axial images). Left temporoparietal hypodensity extending into left cerebral peduncle with faint central hyperdensity with mass effect and midline shift of 5mm
Mentions: Laboratory testing which including a complete blood count, renal function test, liver function test, serum electrolyte, inflammatory markers such as erythrocyte sedimentation rate and C- reactive protein, viral serology, including human immunodeficiency virus (HIV), and blood cultures did not yield any abnormalities. An initial computed tomography (CT) of his brain showed an ill-defined left temporoparietal hypodensity with a faint central hyperdensity with mass effect and midline shift (Fig. 1). Due to the high suspicion of cerebral venous/arterial thrombosis, MRI of his brain as well as magnetic resonance venography (MRV) and magnetic resonance angiography (MRA) were performed. Imaging showed a mass involving his left thalamus, midbrain, and pons. The lesion resulted in mild fullness of the ipsilateral lateral ventricle due to compression of left foramen of Monro with midline shift (Fig. 2). MRV and MRA were unremarkable (Fig. 3). After reviewing his past medical history, he reported heavy cigarette smoking with recurrent episodes of painful mouth and genital ulcers which were treated with low-dose steroids for the last 10 years. His family history was unremarkable for chronic or inherited disease and there was no obvious precipitating factor for his current condition. After consulting the neurologist, the space-occupying lesion in his brain was suspected to be a brain tumor and a brain biopsy was advised; however, the patient refused and preferred medical treatment instead.Fig. 1

Bottom Line: 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.If the response to steroids is minimal then a brain biopsy should be performed.

View Article: PubMed Central - PubMed

Affiliation: Al-Adan Hospital, Hadiya, Kuwait. dr.alfedaghi@hotmail.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.

No MeSH data available.


Related in: MedlinePlus