Thrombophlebitis in Behçet's disease: two causes of diagnostic error

✍ Scribed by M'Hamed Hamza

• Publisher: John Wiley and Sons
• Year: 1984
• Tongue: English
• Weight: 112 KB
• Volume: 27
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780270621

✦ Synopsis

with interest the letter of Mulhern and Pollock (1) in which they reported a case of Behqet's disease with pseudothrombophlebitis. I have seen 2 similar cases, and a third case in which localized myositis of the calf simulated thrombophlebitis.

The first patient, a 30-year-old man, was followed for 8 years for Behqet's disease; his symptoms included oral and scrota1 aphthosis, necrotic pseudofolliculitis, skin hypersensitivity to pricking, and recidivant acute arthritis. In January 1983, the patient was admitted to the hospital for acute arthritis of the left knee with associated swelling, and a painful and strained left calf.

Laboratory studies revealed the following values: erythrocyte sedimentation rate, 60 mmlhour; leukocytes, 11,6OO/p1 (neutrophils, 90%; lymphocytes, 10%); no antinuclear antibodies or rheumatoid factor were found in the serum. Arthrocentesis of the left knee revealed 20 cc of cloudy fluid, white blood cells (WBC) 22,000/mm7, and a negative culture. An arthrogram of the left knee showed a ruptured popliteal cyst with fusion of the contrast preparation in the calf (Figure I). Phlebography of the left lower limb showed permeability of the venous system.

Patient 2, a 47-year-old man, was hospitalized for Behcet's disease and venous thrombosis. His symptomsoral and genital aphthosis, necrotic psuedofolliculitis, and skin hypersensitivity-began 3 months prior to admission. Two months later, arthritis appeared in the left knee with associated swelling and tenderness in the ieft calf. Arthrocentesis of the left knee revealed 30 cc of cloudy fluid, WBC 10,000/mm3, germ-free. Erythrocyte sedimentation rate was 112 mm/hour; leukocytes, 12,60O/pI (neutrophils, 65%; lymphocytes, 34%; monocytes, 1%). No antinuclear antibodies