Pseudoaneurysm of the Femoral Artery - An Unusual Presentation of Behcets Disease

Abstract

Behcet's disease is a multisystem disorder of probable autoinflammatory etiology with manifestations that can affect many organ systems. We present a patient with the unusual presentation of splenic infarction and pseudoaneurysm of the iliac artery. Behcet's disease should be included in the differential diagnosis of pseudoaneurysms if they are accom- panied by other classic features of this interesting disease. After blood cultures were obtained, antibiotic therapy was initiated with ampicillin and garamycin for treatment of suspected bacterial endocarditis, and when initial blood cul- tures returned sterile he was given ceftriaxone as treatment for HACEK organisms. Transthoracic and transesophageal echocardiographs revealed normal cardiac anatomy with no evidence of vegetations. In spite of antibiotic therapy, fevers between 38 - 39° persisted for one week. After PCR for bac- terial antigens returned negative, antibiotic therapy was dis- continued. The patient continued to complain of left inguinal and left back pain, and repeat CT angiography revealed that the pseudoaneurysm had become enlarged. The possibility of vasculitis was raised and serological studies were performed, including p-ANCA, C-ANCA, anti-double-stranded DNA, hepatitis, B, C, HIV, antibodies to antiphospholipids, and HLA B51, all of which were negative.