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A case series of intracardiac thrombi and vascular involvement in pediatric Behçet’s disease

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Abstract

To evaluate the general characteristics of pediatric Behçet’s disease (BD) patients with thrombus and to present the clinical features, treatment responses and prognosis of patients with intracardiac thrombus. The clinical characteristics and outcomes of 15 patients with thrombus among 85 pediatric BD patients followed in the Department of Pediatric Rheumatology were evaluated retrospectively. Of the 15 BD patients with thrombus, 12 (80%) were male, 3 (20%) were female. The mean age at diagnosis was 12.9 ± 1.1 years. Thrombus was present at the time of diagnosis in 12 patients (80%), while thrombus developed in three patients within the first three months after diagnosis. The most common site of thrombus was the central nervous system (n = 9, 60%), followed by deep vein thrombus (n = 6, 40%) and pulmonary artery thrombus (n = 4, 26.6%). Three male patients (20%) developed intracardiac thrombus. The overall intracardiac thrombus rate in the 85 patients was 3.5%. Two of the three patients had thrombus in the right, and one had thrombus in the left heart cavity. In addition to steroids, 2 of the 3 patients received cyclophosphamide, while the patient with thrombus localized in the left heart cavity was given infliximab. In the follow-up, the two patients with thrombus in the right heart cavity were switched to infliximab because of resistance to cyclophosphamide. Complete resolution was observed in 2 of the 3 patients on infliximab; a significant reduction in the thrombus of the other patient was achieved. Intracardiac thrombus is a rare presentation of cardiac involvement in BD. It is usually observed in males and in the right heart. Although steroids and immunosuppressive agents such as cyclophosphamide are recommended as first-line treatment, favorable outcomes can be achieved with anti-TNFs in resistant cases.

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Data availability

The data that support the findings of this study are available from the corresponding author, (SC), upon reasonable request.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey

    Serkan Coşkun, Zahide Ekici Tekin, Vildan Güngörer, Elif Çelikel, Tuba Kurt, Merve Cansu Polat, Pakize Nilüfer Tekgöz, Müge Sezer, Cüneyt Karagöl, Melike Mehveş Kaplan, Nimet Öner & Banu Çelikel Acar

  2. Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey

    Hazım Alper Gürsu & Ahmet Vedat Kavurt

  3. Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey

    Zeliha Güzelküçük & Namık Yaşar Özbek

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  1. Serkan Coşkun
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Contributions

All authors made substantial contributions to the conception or design of the work, have approved the final manuscript, and takes full responsibility for the manuscript. SC, BCA: reviewed and revised the manuscript, ZET, EC, VG, ZG, NYO and BCA: contributed to the writing of the manuscript, TK, NT, MS, CK, NO, MMK, HAP, AVK and MCP: were responsible for data collection and analysis.

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Correspondence to Serkan Coşkun.

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There is no conflict of interest for any author.

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The study was approved by the Ankara City Hospital, ethics committee before the study. (Ethics Committee Approval No/Date: E2-22-1864/05.27.2022).

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Coşkun, S., Ekici Tekin, Z., Güngörer, V. et al. A case series of intracardiac thrombi and vascular involvement in pediatric Behçet’s disease. Rheumatol Int 43, 1161–1171 (2023). https://doi.org/10.1007/s00296-023-05292-8

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