Delirium: Fallout of Neuro-Behcet’s Disease – A Case Report

Abstract

Here, we present a case of an elderly male with hypertension and diabetes, who presented to ER with delirium, ataxia, and slurring of speech associated with altered psychomotor behaviour, also features such as anorexia, painful erythematous patches over extremities, tender knee, and ankle joints were conspicuous at presentation. A brain scan on admission revealed multiple lacunar cerebellar infarcts, whereas routine blood investigations did not reveal anything substantial contributions to the cause of presenting symptoms, including negative serology for ANA, DS-DNA, HAL-B51, and anticardiolipin antibodies, done to rule in, presence of systemic autoimmune causes for the gamut of clinical features at presentation. Contemplation over past and associated clinical features, such as ocular ailment, recurrent aphthous ulcers, dermatological lesions (erythema nodosum and peudofolliculitis), and past MRI showing lesions in the thalamus and pons (diencephalon predilection) a diagnosis of Behcet’s disease (BD) was considered based on ‘International Study Group Diagnostic Criteria for BD’. More so in the event of no better explanation for the neurological involvement, in a diagnosed case of BD, presenting delirium was considered to be the fallout of Neuro-Behcet’s Disease (NBD). The Patient responded to steroids and was discharged on a combination of tapering doses of steroids with Azathioprine. Emphasising the fact that the central nervous system affection in a case presenting with signs of systemic inflammation, autoimmune vasculitis as a cause of neurological involvement should be considered, as this is critical for deciding onto the course of treatment. NBD being secondary to systemic vasculitis as compared to atherosclerotic vascular affection seen in regular stroke, require steroids and immunomodulators rather than antiplatelets and anticoagulants.