Favorable evolution of a pseudoaneurysm of the aortic arch in Behçet's disease under medical treatment: A case report

Behçet's disease is a multisystem vasculitis of undefined etiology. Aneurysms or pseudoaneurysms of the aortic arch constitute one of the major complications during the course of Behçet's disease. We report the case of a patient who presented for a consultation due to chest pain. The diagnosis of Behçet's disease was made based on clinical arguments, the pathergic test, and was confirmed by a thoracic angioscanner that revealed a 30 mm pseudoaneurysm of the aortic arch. Given the urgency of the treatment, a 3-day bolus of Solu-Medrol was administered, followed by oral treatment. After 12 months of follow-up, the patient reported a marked clinical improvement. The control angioscanner indicated an almost complete disappearance of the pseudoaneurysm of the aortic arch. The thoracic involvement of angio-Behçet is severe and poses a risk to vital prognosis; the choice between surgical treatment and medical monitoring is very difficult. In this article, we present a rare and significant evolution that opens up a substantial discussion on the role of immunosuppressive treatment in the management of pseudoaneurysms revealed by Behçet's disease.