SHM Converge Scientific Abstract ePoster Gallery-This Disease Is Not Your Bud

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This case describes a 38-year-old African American woman with recurrent oral and genital ulcers who initially presented with acute abdominal pain. Imaging showed multiple intraabdominal venous thromboses, including hepatic venous obstruction with a classic “nutmeg liver” appearance, consistent with Budd-Chiari syndrome (BCS). Her hypercoagulable workup was unrevealing, and she was anticoagulated, but Behçet disease (BD) was not recognized at that time.<br /><br />Her course later worsened with cirrhosis and subacute neurologic symptoms. A brain biopsy supported neuro-Behçet disease, leading to the correct diagnosis. She was treated with pulse-dose steroids, azathioprine, and adalimumab, with significant clinical improvement.<br /><br />The discussion highlights that BD is a chronic multisystem inflammatory disorder characterized by mucocutaneous ulcerations and vasculitis. Vascular involvement occurs in up to 30% of patients and is a major cause of morbidity and mortality. Venous thrombosis is more common than arterial disease, and BCS is a rare but serious complication, with reported prevalence around 3.2%. The underlying mechanism is thought to involve endothelial dysfunction and inflammation-driven thrombosis.<br /><br />A key teaching point is that prevention of venous thrombosis in BD depends mainly on controlling systemic inflammation rather than routine primary anticoagulation. In BD-associated BCS, treatment should include glucocorticoids plus another immunosuppressive agent, while the benefit of anticoagulation remains controversial.<br /><br />The conclusion emphasizes that BCS should prompt consideration of Behçet disease, especially in patients with recurrent oral-genital ulcers and ocular findings. Early recognition and immunosuppressive therapy may prevent severe vascular complications and alter the disease course.

Asset Subtitle

Sarah Al Allawi

Meta Tag

Author List Sami Tahhan, Sarah Al Allawi

Category Clinical Vignettes

Concept Behçet Disease

Concept Vascular Involvement

Concept Ulceration

Concept Venous Thrombosis

Concept Budd-Chiari Syndrome

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School

Presenting Author Sarah Al Allawi

Track Adult

Keywords

Behçet disease

Budd-Chiari syndrome

venous thrombosis

oral ulcers

genital ulcers

neuro-Behçet

hepatic venous obstruction

vasculitis

immunosuppressive therapy

adalimumab

Behçet Disease

Vascular Involvement

Ulceration

Venous Thrombosis

Budd-Chiari Syndrome