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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
AFRICA
e3
cause of death in Behcet’s disease. Other complications such as
thrombosis and dissection have also been reported.
4
In the majority of cases, patients develop coronary events
several months or years after having been diagnosed and treated
for Behcet’s disease. Less commonly, coronary complications
may occur as the first manifestation of the disease, such as in
this case.
5
Early initiation of immunosuppressive therapy is
recommended for the management of coronary artery aneurysms
due to Behcet’s disease. Corticosteroids, colchicin, azathioprine
and cyclophosphamid were the most commonly used agents in
previous reports.
6
Management of these patients might be challenging
because of the increased risk of bleeding, scar thinning and
myocardial rupture on the combination of antithrombotic
therapy and corticosteroids. Radical treatment is mostly surgical,
including aneurysm resection or ligation with coronary artery
reconstruction or coronary artery bypass grafting.
4
In some
cases, percutaneous interventions are performed using covered
stents.
7
These interventions are usually indicated after clinical
remission on corticosteroids and immunosuppressive therapy
because coronary manipulation in the active phase may expose
patients to complications.
6
Conclusion
Although coronary artery aneurysm is a rare manifestation
of Behcet’s disease, it should be suspected in cases of acute
coronary syndrome in young patients with no cardiovascular
risk factors. As the presence of cardiac involvement worsens the
prognosis of Behcet’s disease, prompt diagnosis and initiation
of immunosuppressive therapy are of paramount importance
before surgical or percutaneous management of the aneurysm.
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