Abstract Details

Title Neuro-Behcets Disease; a Case Study

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 223

Objective

Background BACKGROUND: Case report of a patient with the previous diagnosis of Multiple Sclerosis who is later diagnosed with Neuro-Behcets Disease.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: 33 year-old black women with a past medical history of recurrent aphthous ulcers and Relapsing-Remitting Multiple Sclerosis presented with acute left hemiplegia and hemisensory deficits. In 2005, she had monocular vision loss, which improved with steroids. In 2006, she developed lethargy, nausea, and vomiting which prompted a hospital evaluation. MRI brain revealed a large edematous mass involving the corpus collosum suspicious for a tumor. Brain biopsy showed T cell infiltration, rare B cells, and macrophages consistent with demyelinating disease. Lumbar puncture was negative for oligioclonal bands. She was diagnosed with Multiple Sclerosis, given steroids and Rebif and was symptom-free for two years. She next developed left sided weakness and numbness. Physical exam was notable for dysarthria, left hemiparesis, hemisensory deficits, and an ulcerative tongue lesion. Laboratory studies were significant for an elevated ESR and CRP. The following studies were normal: HIV, ACE, hypercoagulation panel, vasculitis panel, and hepatic panel.CSF cell count, protein, glucose, gram stain, oligoclonal bands, HSV PCR, and cytology were normal. MRI brain revealed a new non-enhancing right thalamic lesion extending down to cerebral peduncle. Past history of vaginal ulcerative lesions and uveitis was then disclosed. Initial biopsy slides were re-examined concluded that the histological features were not typical of Multiple Sclerosis. Based upon her history, reanalysis of the biopsy sample, and brain imaging, a diagnosis of Neuro-Behcets disease was made.

Conclusions CONCLUSIONS: Neuro-Behcets disease is an rare disease that should be included in the differential diagnosis in patients with MRI lesions atypical for Multiple Sclerosis. This diagnosis can be reached by taking a careful history. It is imperative to diagnose Neuro-Behcets disease in order to monitor and treat both neurologic and systemic manifestations.

Authors/Disclosures
Karen Medin, DO (Veteran Affairs Medical Center) PRESENTER	No disclosure on file
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .
Benny S. Kim, MD	Dr. Kim has nothing to disclose.
Cara E. Harth, MD, FAAN (Stony Brook University Hospital)	Dr. Harth has received personal compensation in the range of $500-$4,999 for serving as a In-House Expert Reviewer with Academic Group.
Lauren B. Krupp, MD, FAAN (NYU Langone Medical Center)	Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medscape. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EBIX. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hoffman LaRoche. Dr. krupp has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for MMMK. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Patrick, Dolan, and Kaufman. Dr. krupp has received intellectual property interests from a discovery or technology relating to health care.
Arianna Sartori, MD (Osp.Trieste di cattinara)	No disclosure on file

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