Behcet's disease presenting as malignant hypertension induced by renovascular hypertension.
Behcet’s disease
Malignant hypertension
Renovascular hypertension
Journal
CEN case reports
ISSN: 2192-4449
Titre abrégé: CEN Case Rep
Pays: Japan
ID NLM: 101636244
Informations de publication
Date de publication:
30 Jul 2024
30 Jul 2024
Historique:
received:
07
06
2024
accepted:
22
07
2024
medline:
30
7
2024
pubmed:
30
7
2024
entrez:
30
7
2024
Statut:
aheadofprint
Résumé
Hypertension is an uncommon manifestation of Behcet's disease, which is also an uncommon cause of renovascular hypertension. We herein report a case of malignant hypertension associated with unilateral renal artery stenosis due to vascular Behcet's disease. A 19-year-old man, who had no significant medical history, was referred to ophthalmology at our hospital because he was suspected to have uveitis and Vogt-Koyanagi-Harada syndrome. In addition to poor eyesight, he had been aware of a fever, loss of appetite, and weight loss for a month. He was admitted with markedly elevated blood pressure (222/140 mmHg), hypertensive retinopathy, and acute kidney injury, who was diagnosed with malignant hypertension. Laboratory findings showed high plasma renin activity and plasma aldosterone concentration, hypokalemia, and elevated inflammatory response. Computed tomography showed an atrophic right kidney and a compensatorily enlarged left kidney. Renal computed tomography angiography revealed severe and diffuse stenosis of the right renal artery, and stenosis of the ostium of celiac artery. Since he was suspected to have uveitis and his inflammatory responses were elevated on admission, we listed Behcet's disease as a differential diagnosis. Medical interview and examination focusing on Behcet's disease revealed that the patient had recurrent oral aphthous lesions and folliculitis, and a positive pathergy test, which led to the patient being diagnosed with vascular Behcet's disease. After admission, his blood pressure was well controlled with multiple antihypertensive drugs including an angiotensin receptor/neprilysin inhibitor, and his oral aphthous lesions and skin lesion were improved with colchicine. When young men who are at a higher risk for vascular Behcet's disease show renovascular hypertension with an elevated inflammatory reaction, vascular Behcet's disease should be considered as a differential diagnosis.
Identifiants
pubmed: 39078578
doi: 10.1007/s13730-024-00918-7
pii: 10.1007/s13730-024-00918-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.
Références
Karadag O, Bolek EC. Management of Behcet’s syndrome. Rheumatology(Oxford). 2020;59:iii108–17.
doi: 10.1093/rheumatology/keaa086
pubmed: 32348509
Alibaz-Oner F, Direskeneli H. Management of vascular Behçet’s disease. Int J Rheum Dis. 2019;22:105–8.
doi: 10.1111/1756-185X.13298
pubmed: 29665281
Saadoun D, Asli B, Wechsler B, Houman H, Geri G, Desseaux K, et al. Long-term outcome of arterial lesions in Behçet disease: a series of 101 patients. Medicine (Baltimore). 2012;91:18–24.
doi: 10.1097/MD.0b013e3182428126
pubmed: 22198498
Koç Y, Güllü I, Akpek G, Akpolat T, Kansu E, Kiraz S, et al. Vascular involvement in Behçet’s disease. J Rheumatol. 1992;19:402–10.
pubmed: 1578454
Wang X, Zhou Z, Li J, Su G, Li X. Hypertension as a prominent manifestation secondary to renal artery lesions in pediatric Behcet’s disease. Pediatr Rheumatol Online J. 2024;22:19.
doi: 10.1186/s12969-023-00932-6
pubmed: 38243321
pmcid: 10797725
Zheng W, Li G, Zhou M, Chen L, Tian X, Zhang F. Renal involvement in Chinese patients with Behcet’s disease: a report of 16 cases. Int J Rheum Dis. 2015;18:892–7.
doi: 10.1111/1756-185X.12529
pubmed: 25557053
International Team for the Revision of the International Criteria for Behçet’s Disease (ITR-ICBD). The international criteria for Behçet’s disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014;28:338–47.
doi: 10.1111/jdv.12107
Yamamoto K, Rakugi H. Angiotensin receptor-neprilysin inhibitors: comprehensive review and implications in hypertension treatment. Hypertens Res. 2021;44(10):1239–50.
doi: 10.1038/s41440-021-00706-1
pubmed: 34290389
Tersalvi G, Dauw J, Martens P, Mullens W. Impact of sacubitril-valsartan on markers of glomerular function. Curr Heart Fail Rep. 2020;17(4):145–52.
doi: 10.1007/s11897-020-00463-1
pubmed: 32488503
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235–481.
doi: 10.1038/s41440-019-0284-9
pubmed: 31375757
Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, et al. First international consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019;24(2):164–89.
doi: 10.1177/1358863X18821816
pubmed: 30648921
Plouin PF, Baguet JP, Thony F, Ormezzano O, Azarine A, Silhol F, ARCADIA Investigators, et al. High prevalence of multiple arterial bed lesions in patients with fibromuscular dysplasia: the ARCADIA registry assessment of renal and cervical artery dysplasia. Hypertension. 2017;70(3):652–8.
doi: 10.1161/HYPERTENSIONAHA.117.09539
pubmed: 28716989
Kim ESH, Olin JW, Froehlich JB, Gu X, Bacharach JM, Gray BH, et al. Clinical manifestations of fibromuscular dysplasia vary by patient sex: a report of the United States registry for fibromuscular dysplasia. J Am Coll Cardiol. 2013;62(21):2026–8.
doi: 10.1016/j.jacc.2013.07.038
pubmed: 23954333
Lüscher TF, Lie JT, Stanson AW, Houser OW, Hollier LH, Sheps SG. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62(10):931–52.
doi: 10.1016/S0025-6196(12)65051-4
pubmed: 3309488
Emmi G, Bettiol A, Silvestri E, Di Scala G, Becatti M, Fiorillo C, et al. Vascular Behçet’s syndrome: an update. Intern Emerg Med. 2019;14:645–52.
doi: 10.1007/s11739-018-1991-y
pubmed: 30499073
Wakui H, Hosokawa Y, Oshikawa J, Tamura K, Toya Y, Yabana M, et al. Endovascular treatment of renal artery stenosis improves contralateral renal hypertrophy with nephrotic syndrome. CEN Case Rep. 2014;3:53–5.
doi: 10.1007/s13730-013-0085-y
pubmed: 28509242
Saadoun D, Asli B, Wechsler B, Houman H, Geri G, Desseaux K, et al. Long-term outcome of arterial lesions in Behçet disease: a series of 101 patients. Medicine (Baltimore). 2012;91(1):18–24.
doi: 10.1097/MD.0b013e3182428126
pubmed: 22198498
Ko GY, Byun JY, Choi BG, Cho SH. The vascular manifestations of Behçet’s disease: angiographic and CT findings. Br J Radiol. 2000;73(876):1270–4.
doi: 10.1259/bjr.73.876.11205670
pubmed: 11205670
Akkuzu G, Özgür DS, Karaalioğlu B, Yalçın Mutlu M, Yıldırım F, Erdoğan M, et al. Behcet’s syndrome resembling takayasu’s arteritis with the distribution of arterial involvement: a case report and literature review. Eur J Rheumatol. 2023;10:62–6.
doi: 10.5152/eurjrheum.2023.22043
pubmed: 37470383
pmcid: 10544313
Thuaire C, Damade R. Behçet’s disease presenting as renovascular hypertension treated successfully with percutaneous angioplasty. Am J Med Sci. 2016;352:655–6.
doi: 10.1016/j.amjms.2016.04.021
pubmed: 27916225