Intracardiac thrombosis in Behçet disease: Predictable complications associated with the risk of sudden death

Abstract

Dear Editor, Although vascular manifestations are the main predictors of mortal‐ ity in Behçet disease (BD),1 it is important to note that these patients tended to deny any history of genital ulcers, joint pain, and skin rash. Thus, the important issue about vasculo‐Behçet is which biomarkers can predict cardiac complications. We describe a case of recurrent erythema nodosum (EN) which developed large intracardiac thrombi consistent with vasculo‐Behçet. A 32‐year‐old man presented with a 2‐month history of painful indurated erythema on his legs (Figure 1A,B) and episodic fever. Physical and laboratory examination were unremarkable except for slight CRP elevation (1.5 mg/dL). Histological examination of the er‐ ythema was consistent with EN (Figure 1C). He did not fulfill the International Criteria for BD.2 Although he was under an excellent disease control with colchicine, CRP levels increased progressively without any clinical symptoms of BD (Figure 1A). Seven months later, he presented to the cardiovascular department with dyspnea and abnormal electrocardiogram findings. Three‐dimensional com‐ puted tomography showed a large thrombus in the right ventricle (Figure 1D). Cardiac catheterization confirmed right ventricular thrombi. He was started on oral prednisolone and warfarin. His pre‐ sentation could then be considered consistent with vasculo‐Behçet. One month later, the thrombi had disappeared. A review of case reports suggests that cardiac complications in BD may remain entirely asymptomatic until patients present with an acute cardiac event.1,3,4 Of note, many patients presented with