Neuro-Behcet's Disease Manifesting as a Neoplasm-Like Lesion. Case Report.

Abstract

A 50-year-old man presented with neuro-Behçet's disease (NBD) manifesting as a large neoplasm-like lesion affecting the brainstem, basal ganglia, and white matter of the cerebral hemisphere. He had no history of disease except for psychoneurosis. On admission, neurological examination found left hemiparesis and dysarthria. Magnetic resonance (MR) imaging showed multiple small ring-like enhancement in the basal ganglia, brainstem, and deep white matter. Biopsy of the mass was performed. Histological examination revealed invasion of inflammatory cells in the white matter, especially around the blood vessels. After the brain biopsy, the patient developed oral aphthae, genital ulcers, and skin eruptions, which are indicative of Behçet's disease. MR imaging after three courses of steroid pulse therapy revealed that the edematous lesion had become smaller with minimum midline shift. NBD should be considered in the differential diagnosis of lesions with multiple ring-like enhancement extending from the basal ganglia to the brainstem, because dermatological manifestations are sometimes obscured during periods of remission.

Neuro-Behcet's disease mimicking multiple brain tumors: Diffusion-weighted MR study and literature review

“…However, there were still limitations in differential diagnosis with tumor, abscess, multiple sclerosis, and other vasculitis [11][12][13][14][15][16][17][18][19]. Central necrotic lesion like our case could be confused with brain tumor or abscess, and stereotactic biopsy has been recommended [6,20].…”

Ptosis and Mass Like Lesions in Behçet’s Disease: A Rare Presentation

“…There is no accepted specific treatment for the maintenance period but some authors suggested a life-long colchicine (1-2 mg/day), acetylsalicylic acid, and low dose corticosteroid treatments. 2,3,12 In published cases, the most common maintenance therapy was immunosuppression with cyclophosphamide or azathioprine with a dramatic improvement in clinical and radiologic manifestations in 83% of patients. 2,3,12 We also planned cyclophosphamide treatment after the intravenous pulse steroid.…”

Tumefactive Neuro-Behcet’s Disease: A Case Report and Review of the Literature

“…We searched tumefactive NBD case reports in English based literature and found 10 biopsy proven cases that had mass effect in brain MRI by means of midline shift and/or ventricular compression so far [4][5][6][7][8][9][10][11][12][13]. Data regarding age, gender, complaints at admission, neurological symptoms, CNS imaging, histopathologic findings and treatment response were summarized including our case in Table 1 (11 cases).…”

“…The brain magnetic resonance imaging (MRI) lesions are usually localised in brainstem and basal ganglia in parenchymal NBS. There have been 10 biopsy-proven tumefactive NBD case reports in English based literature so far [4][5][6][7][8][9][10][11][12][13]. We evaluated histopathological properties of all the cases including our case.…”