Budd-Chiari syndrome associated to Behcet disease: An observational retrospective multicenter study in Morocco.

Budd-Chiari syndrome (BCS) is considered a rare but serious complication of Behçet's disease (BD). This study was performed to define the prevalence, clinical and biological features, treatment, and clinical course of BSC associated with BD in a Moroccan population. We retrospectively analyzed the medical records of 1578 patients fulfilling the international diagnostic criteria for BD, including those with BSC. Eighteen male and 3 female patients, with a mean age of 36 ± 8.6 years. The inferior vena cava was involved in 81% (n = 17) of cases. All forms of BCS were noted: the chronic form in 52.4% (n = 11), the subacute form in 38% (n = 8), and the fulminant form (2 cases). Ascites was the main clinical sign and was present in 62% of patients (n = 13). Other venous thromboses (superior vena cava and lower limbs) were associated with BSC in 52.4% of patients (n = 11). Arterial involvement was noted in 28.6% (n = 6). Cardiac manifestations were present in 19% (n = 4) of the patients. All the patients received anticoagulants associated with corticosteroids. Immunosuppressants were used in 95% (n = 20). One patient received infliximab. Severe complications were noted in 38% (n = 8) of patients (digestive bleeding, confusion, infections and liver failure). Four patients have died during the study period. BCS in patients with BD is not uncommon and can be life threatening. It is frequently associated with other vascular manifestations that can be difficult to treat, particularly in the presence of pulmonary artery aneurysms. Prognosis improved with the use of immunosuppressants. Biologics can be promising in the early stages.

[Causes of stroke among young people: role of the internist]. / Etiologies des accidents vasculaires cérébraux ischémiques chez les jeunes: apport de l'interniste.

In young people brain ischemias vary according to their cause and prognosis. In internal medicine they have a specific cause, considering the tertiary source of recruitment. Our study aimed to provide informations about some specific causes of this disease in young subject. We conducted a retrospective study by reviewing the medical records of young patients hospitalized at the Department of Internal Medicine in Casablanca over the period 2000-2014. All patients underwent CT scan angiography and/or magnetic resonance angiography that determined the nature and the topography of the ischemic stroke. Clinical examination was followed by appropriate investigations to determine the cause of brain ischemia. Data were collected from twenty-five patients, with a sex ratio of 0.73 and an average age of 36±7. Smoking was reported in 32% of cases, diabetes and high blood pressure were found in 8% of cases. Amnesia and migraine episodes were found in 24% of cases. Combination estrogen-progestin and a history of miscarriage were reportedin 12% of cases. Ischemic strokes were mainly caused by acute systemic lupus (32%) associated with antiphospholipid syndrome (80%), Behcet's disease (16%), Takayasu's disease (12%). In addition to anti-aggregation treatment, 76% of patients underwent corticosteroid and immunosuppressive therapies. Internists are involved in the treatment of patients with ischemic stroke, in particular to determine its cause. The causes of brain ischemias in young people are multiple. Research has to be rigorous in order to identify specific causes, to evaluate the risk of recidivism and to establish a therapeutic approach.