Recurrent Mouth Research Articles

Lymphomatoid papulosis localized to the oral mucosa: case report and literature review

Introduction: Lymphomatoid papulosis is a primary CD 30+ cutaneous lymphoproliferation. Observation: We report the case of a 39-year-old patient who presented with ulcers on the back of the tongue, gums, buccal mucosa, and soft palate, which evolved as spontaneously regressive flare-ups. The diagnosis of inflammatory bowel disease was initially proposed. Several years later, the patient presented an ulcer on the left middle finger. Histological examination confirmed the diagnosis of lymphomatoid papulosis. Discussion: This chronic dermatosis manifests a single rash or multiple papulonodular rashes, evolving as spontaneously regressive flare-ups. Mucosal involvement is rare, and no prognostic factor for this location has been highlighted to this date. Pathological examination is essential. Conclusion: The mucosal involvement of lymphomatoid papulosis is one of the diagnoses to be considered for recurrent mouth ulcers.

Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008-2015.

Using China's national surveillance data on hand, foot and mouth disease (HFMD) for 2008-2015, we described the epidemiologic and virologic features of recurrent HFMD. A total of 398,010 patients had HFMD recurrence; 1,767 patients had 1,814 cases of recurrent laboratory-confirmed HFMD: 99 reinfections of enterovirus A71 (EV-A71) with EV-A71, 45 of coxsackievirus A16 (CV-A16) with CV-A16, 364 of other enteroviruses with other enteroviruses, 383 of EV-A71 with CV-A16 and CV-A16 with EV-A71, and 923 of EV-A71 or CV-A16 with other enteroviruses and other enteroviruses with EV-A71 or CV-A16. The probability of HFMD recurrence was 1.9% at 12 months, 3.3% at 24 months, 3.9% at 36 months, and 4.0% at 38.8 months after the primary episode. HFMD severity was not associated with recurrent episodes or time interval between episodes. Elucidation of the mechanism underlying HFMD recurrence with the same enterovirus serotype and confirmation that HFMD recurrence is not associated with disease severity is needed.

LATE DIAGNOSIS OF UVEITIS IN A GIRL WITH BEHСET'S DISEASE: DEMONSTRATION OF A CLINICAL CASE

Behсet's disease (BD) is systemic vasculitis with multiorgan failure. According to the 1990 International Study Group for Behсet's disease (ISGBD) criteria, the main manifestations of the disease include recurrent mouth and genital ulcers; skin and eye lesions. Inflammatory diseases of the eye are diagnosed in 50–70% of patients with BD. Our described case illustrates the late diagnosis of BD in a 13-year-old girl, which led to severe eye disease (significantly decreased visual acuity of the left eye) 2 years after disease onset. The lesion of ocular posterior segments is the pathognomonic sign of BD. This symptom concurrent with other major manifestations of BD (skin and genital lesions) and the ethnicity of the patient (a resident of Dagestan, the region through which there was the Great Silk Road) should have promoted the earlier diagnosis of the disease.

Bilateral Hemophthalmus — the First Symptom of Behcet’s Disease (Clinical Case)

Behcet’s disease (BD) — a systemic chronic idiopathic inflammatory recurrent disease of unknown etiology. The development of the disease involve a combination of various factors, among them the most important is genetic and infectious. Eye lesion is one of the most frequent and severe symptoms of Behcet’s disease. According to the literature, eye lesion appears in 54–90% cases. There are several types of Behcet’s disease: the front, posterior and panuveitis, retinal vasculitis, occlusion of the branches of the central retinal vein, episcleritis, scleritis, keratitis, anterior ischemic neuropathy, paralysis of the extraocular muscles, swelling of the macula. In 95% cases the process is bilateral, but the clinical signs are often asymmetrical. Ocular pathology usually develops after 2–3 years the onset of symptoms BD. We havn’t met in the literature any case of Behcet’s disease, which has begun with hemophthalmia. Taking all these points together it seems to us interesting to present a clinical case of Behcet’s disease which has debuted with a bilateral hemophthalmus. This article describes a clinical case of Behcet’s disease in a patient of 38 years old. The interest of this observation is caused by feature of the appearance of clinical symptoms. Bilateral hemophthalmus has originally appeared, twice (in 2013 and 2014) and has been treated. During the next hospitalization the treatment has produced the positive effect was less pronounced. After that, patient has undergone bilateral vitrectomy (2014). In April 2015 there were recurrent mouth ulcers, and 3 months later groin ulcers has appeared, pain in the joints. The ophthalmologist examination has shown commenmorative signs of left uveitis. The patient was counseled at the Institute of Rheumatology, where were determined the diagnosis of Behcet’s disease.This paper shows the clinical data and the results of additional tests (OCT, fluorescein angiography, ultrasonography), the results of blood biochemical examination and immune status.

Behcet's Disease: Is There Geographical Variation? A Review Far from the Silk Road.

Behcet's Disease (BD) is a systemic vasculitis characterized by the triad of recurrent mouth and genital ulcers with eye involvement. To date there are no laboratory tests specific for the disease and diagnosis continues to remain on clinical grounds. Multiple criteria have been created as guides for diagnosis; however, given the wide spectrum of organ involvement, some cases remain undiagnosed. The diagnosis of Behcet's Disease may only be made over time as the clinical manifestations emerge sometimes separated by months and even years. With an increased recognition of this disease it has become apparent that there is geographical variation in clinical manifestations. In particular cardiac manifestations are not seen commonly in Caucasians compared to Asian and Middle Eastern patients, while neurological manifestations are more common in Caucasians. Use of immunosuppressive and immunomodulatory drugs to suppress inflammation remains the cornerstone of treatment.

Exudative pleural effusion associated with Behcet's disease

Background : Behcet's disease is a rare immune mediated small vessel systemic vasculitis in which diagnosis is mainly clinical and requires the presence of recurrent oral ulcers and at least two additional criteria that includes recurrent mouth and genital ulcers, skin lesions, eye inflammation (uveitis) and a positive pathergy reaction. Methods : The case records of an 82 year old female Nigerian who presented to the medical outpatient clinic of the Federal Medical Centre, Yenagoa with a six months' history of recurrent oral ulcers, diarrhoea, arthralgia, blurring of vision, breathlessness, abdominal pain and extreme weakness was reviewed. Results : She responded well to oral corticosteroids. Conclusion : Behcet's disease should be given consideration in the differential diagnosis of pleural effusion in the presence of recurrent mucosal ulcers. Keywords : Behcet’s disease, Pleural effusion, uveitis, vasculitis

Periodontal Treatment Needs and Oral Ulceration in Children and Adolescents with Celiac Disease

Aim: To determine periodontal treatment needs and the incidence of oral ulceration among children and adolescents with celiac disease and to compare their findings with a healthy age and gender-matched controlgroup. Methods: A prospective study was conducted at King Hussein Medical Center on a total of 86 patients: 43 patients with celiac disease as the study group (comma removed) and 43 healthy age and gender-matched participants as the control group. Both gr oups were questioned for a history of recurrent mouth ulcers (comma removed) and the frequency of tooth brushing. The dental examination for each patient in both groups included the following: plaque index, gingival index (comma removed) and Community Peri odontal Index of Treatment Needs (CPITN). The oral mucosa was examined clinically for any lesion consistent with aphthous ulceration. Results:There were 26 females and 17 males in each group, with a mean age of 13.2 and 13.3 years respectively. Plaque sco res were significantly higher among the study group (p 0.05). Recurrent aphthous ulceration (RAS) was positive among 13 (30.23%) celiac OriginalResearch Article

Neutropenia In Glycogen Storage Disease 1b (GSD1b)

Hypoglycemia, neutropenia, enterocolitis and recurrent infections are common manifestations of glycogen storage disease 1b (GSD1b). GSD1b is a rare genetic disorder caused by mutations in G6PT1, the gene for the glucose 6 phosphate transporter principally responsible for the transport of glucose into the endoplasmic reticulum in neutrophils and other cells. In myeloid cells, mutant G6PT1 causes abnormalities in both neutrophil deployment and function.We recently formed a cooperative GSD1b study group to investigate the diagnosis, manifestations and treatment of GSD1b associated neutropenia. This report summarizes data for 68 patients with GSD1b followed prospectively in North America by the Severe Chronic Neutropenia International Registry-Seattle (SCNIR-Seattle), Duke University and University of Florida. It is the largest cohort of patients yet assembled for the study of this form of glycogen storage disease. We enrolled a total 29 males, 39 females, including 41 currently adult patients (mean age 17.5; range 2.3-41.1). All patients were recognized in very early childhood, most commonly because of hypoglycemia, hepatomegaly, seizures or because of clinical features similar to those of older sibling with GSD1b. Diagnostic DNA sequencing results were available for 30 patients. Before the availability of genetic testing, liver biopsy was commonly done to secure the diagnosis. G-CSF has been widely used in management of these patients since the early 1990's. The earliest treatment of a patient in the cohort began G-CSF in 1989.Neutrophil counts were available for 54/68 patients prior to treatment. Median neutrophil count prior to treatment with G-CSF was 0.45 x 109/L, mean 0.59 +/- 0.09 x 109/L (range 0-3.5 x 109/L) and elevations of blood neutrophils were common with infections. Bone marrow examination and neutrophil function tests were not usually performed. Two-thirds of these patients (42/68) reported symptoms of enterocolitis, a dominant problem for most of these patients. Other common problems were: recurrent fevers, mouth ulcers, gingivitis, periodontitis, cellulitis, abscesses, sinusitis, otitis and pneumonia. Bacteremia, sepsis and deep tissue abscesses were relatively rare. The specific G6PT1 mutations in these patients could not be correlated with the severity of symptoms or neutropenia, similar to previous reports. (Melis et al, Eur J Pediatr 2005;164:501-8)Sixty-six of the 68 patients were treated with G-CSF, starting at a median age 3.9 years (range 0.04-30.4 years) with a median dose of 3.1 mcg/kg/day (range 0.4-13.8 mcg/kg/day), for a median of 9.3 years (range 0.9-23.8 mcg/kg/day). Neutrophils increased in all patients, with median values on treatment 1.28 x 109/L, mean 1.54 +/- 0.14 x 109/L (range 0-5.7 x 109/L). G-CSF doses and blood neutrophil levels were kept relatively low because splenic enlargement is a recognized manifestation of GSD1b. (pre G-CSF 16/68 had splenomegaly, on G-CSF 49/68 patients had splenomegaly), based on spleen size by physical examination.Longitudinal observations indicate that G-CSF consistently increases neutrophil counts, reducing enterocolitis and decreasing the occurrence and severity of infections. The high proportion of adult patients enrolled (60%) suggests that many GSD1b patients are now surviving to adulthood with improvements in overall management. Data from annual follow-up, however, indicate that fever and recurrent infections remain a significant problem for many patients, perhaps because G-CSF dosing to achieve a normal ANC is limited by the risk of massive splenomegaly and neutrophil dysfunction may not be corrected with G-CSF. In our study population, five patients have had splenectomies, four had liver transplants, two had hematopoietic transplants, and two developed AML. Three patients have died, one from AML and two from sepsis; one 18 months post splenectomy and off G-CSF. There are now a total of 4 reported cases of AML in GSD1b, 1 before G-CSF and three in patients treated with G-CSF.We conclude that despite great progress with understanding the genetic and molecular basis for GSD1b and improvement in its treatment, the natural history and long term treatment outcomes are yet poorly understood. Important issues are the risk of bacterial infections despite normalization of the ANC, the risk of massive splenomegaly and the risk of AML. We believe that a cooperative group approach can clarify many of these issues. Disclosures:Dale:Amgen: Consultancy, Research Funding. Boxer:Amgen: Equity Ownership.

Fifteen-minute consultation: a structured approach to the management of recurrent oral ulceration in a child

ObjectiveTo present a structured approach for an outpatient consultation of a child with recurrent mouth ulcers.MethodReview of literature and description of approach followed in our unit.ConclusionsThe literature emphasises the need...

AB0335 Tocilizumab is effective for the treatment of anti-tnf- and rituximab-refractory rheumatoid arthritis

BackgroundA significant proportion of patients with rheumatoid arthritis continue to have active disease and accrue joint damage despite the use of disease modifying anti-rheumatic drugs (DMARDs) and biologicals including anti-TNF...

How to Approach Neutropenia in Childhood

1. Kelly Walkovich, MD 2. Laurence A. Boxer, MD 1. Department of Pediatrics, University of Michigan, Ann Arbor, MI. * Abbreviations: AIN: : autoimmune neutropenia AML: : acute myelogenous leukemia ANC: : absolute neutrophil count CBC: : complete blood cell count MDS: : myelodysplastic syndrome rhG-CSF: : recombinant human granulocyte colony-stimulating factor SCN: : severe congenital neutropenia SDS: : Shwachman-Diamond syndrome WBC: : white blood cell count 1. Patients presenting with recurrent fevers, mouth ulcers and gingivitis should be evaluated for neutropenia. 2. The use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in the management of cyclic neutropenia and severe congenital neutropenia has dramatically decreased clinical symptoms and has decreased mortality from infectious causes. After completing this article, readers should be able to: 1. Recognize patients who have concerning features of history, physical examination, or laboratory results that warrant further investigation for possible neutropenia or other immunodeficiency. 2. Define mild, moderate, and severe neutropenia. 3. Understand that neutropenia can arise from acquired or intrinsic conditions. Know which causes of neutropenia are most commonly encountered in childhood. 4. Recognize why disorders of neutrophil production and release from the bone marrow carry more risk for bacterial infection than peripheral neutropenia associated with normal bone marrow morphology. 5. Understand why neutropenic patients undergoing immunosuppressive therapy are more at risk for a serious bacterial infection than patients who have isolated neutropenia. 6. Understand the impact that treatment with recombinant human granulocyte colony-stimulating factor has had on the outcome of patients who have severe congenital and cyclic neutropenia. 7. Know when to refer to a pediatric hematologist/oncologist. A case study is provided to illustrate key aspects of the care of patients who have neutropenia. A 13-month-old boy presents to his primary care physician for his standard 1-year well-child check. He has had four episodes of otitis media since starting child care, all of which resolved with standard antibiotics. His mother reports that he has been …

Ulcérations buccales aphtoïdes persistantes associées au tocilizumab : deux cas

Tocilizumab, a humanized monoclonal antibody that blocks interleukin-6 receptor, is approved for use in rheumatological diseases. The most frequent adverse events reported are infections. We describe for the first time the occurrence of recurrent aphthous mouth ulcers in two patients on TCZ. Two patients were treated with TCZ for rheumatological disease. A few weeks after administration of TCZ, they presented with multiple painful mouth ulcers that would not heal until TCZ had been withdrawn. In both cases, the oral ulcers resolved 6 to 7weeks after withdrawal of TCZ and readministration of the drug led to recurrence of oral ulcers within 10days in both patients. We describe for the first time the occurrence of aphthous mouth ulcers induced by TCZ. The causative role of TCZ was established by positive rechallenge. These cases were similar to a recently reported case of multiple intestinal aphthous ulcers occurring during TCZ treatment. Such mucosal side effects may be explained by similar inflammatory mechanisms but appear paradoxical because TCZ inhibits a pro-inflammatory cytokine, interleukin 6. TCZ treatment can be maintained if necessary, in combination with colchicine, as reported for one of our patients.

Common Oral Problems and Benign Lesions

There are a number of common oral problems (COPs) that patients may consult their GP about. Some patients are concerned about the appearance of structures within their mouth that are manifestations or variants of normal anatomical structures and only require reassurance. The majority of oral mucosal conditions are benign and do not represent any sinister pathology or an underlying systemic condition. This article describes the clinical presentation of some common oral lesions and conditions. Guidance is given concerning their management and when referral to an oral specialist is required. Recurrent mouth ulcers are the subject of another article in this journal.

Recurrent Mouth Ulcers

Recurrent ulceration of the mouth is a common complaint of patients attending their GP with an oral problem. The majority will have recurrent aphthae, also known as recurrent aphthous stomatitis. This is a painful condition that can significantly affect a patient's quality of life by interfering with eating and speaking. There are a number of other causes of recurrent oral ulceration that are less common but need to be considered by the GP. This article describes the management of patients complaining of recurrent mouth ulcers and provides guidance concerning referral to secondary care.

PWE-051 Retrospective study examining the consequence of neutropaenia during treatment with pegylated interferon-2-α plus ribavirin for hepatitis C infection

<h3>Introduction</h3> A common side effect of treatment with PGI2α and Ribavirin is bone marrow suppression and subsequent neutropaenia. This often results in dose adjustment for fear of rendering patients (pts) more susceptible to serious infection. Our experience is that pts tolerate the neutropaenia without adverse effects and we usually only consider dose reductions if other compelling reasons co-existent. This study was designed to identify the rates of neutropaenia in our treatment group and to determine if they were at greater risk of serious infections. <h3>Methods</h3> All pts who started and completed their treatment for Chronic Hepatitis C infection with combination therapy with PGI2α and ribavirin between April 2006 – September 2009 were included in the study. Three pts failed to attend for follow-up and were excluded from the study. As per BSG guidance, pts had their full blood counts monitored weekly for the first month then monthly thereafter while on treatment. The incidence of serious infection was monitored by reviewing clinical notes and hospital admissions. <h3>Results</h3> Total number of pts included in the study was 120 (Female=29, Male=91). The genotypes of our patient group were as follows: genotype 1a, 43 pts; genotype 1B, 10 pts; genotype 2a, 2 pts; genotype 2b, 9pts; genotype 3a, 55 pts. Pts with genotype 1 had 48 weeks of treatment and pts with genotype 2 or 3 had 24-week of treatment. Doses were weight adjusted as recommended by national guidelines. Neutropaenia was classified as a neutrophil count &lt;1.5×10⁹/l and was observed in 52 pts (43%) (Female=17, Male=35). The degree of neutropaenia was further subdivided into; Mild 1.0×10⁹/l–1.5×10⁹/l (35 pts); Moderate 0.5×10⁹/l–1.0×10⁹/l (14 pts) and Severe &lt;0.5×10⁹/l (3 pts). Dose adjustments were only advised in 3 pts (2 with co-existent neutropaenia and thrombocytopaenia and 1 with recurrent mouth ulcers). Serious infection requiring hospital admission or discontinuation of treatment was not identified in any pts. Of the pts who developed neutropaenia, 46 (88%) had negative PCR at the end of treatment and 40 pts (77%) had sustained virological response (SVR) at 1 year follow-up. <h3>Conclusion</h3> Although the incidence of neutropaenia in pts treated with PGI2α plus Ribavirin is relatively common (43% in our series), the risk of resultant serious infection appears remote. Neutropaenia appears to be a more frequent occurrence in treated female pts (59% females cf. 38% males, p&lt;0.05). Dose reduction is such pts developing neutropaenia as suggested by current guidance appears to be unnecessary and may diminish the likelihood of viral eradication and SVR.

Familial Aicardi–Goutières syndrome due to SAMHD1 mutations is associated with chronic arthropathy and contractures

We report on two siblings doubly heterozygous for null mutations in the recently identified AGS5 gene SAMHD1. The older female child showed mild intellectual disability with microcephaly. Her brother demonstrated a significant spastic paraparesis with normal intellect and head size. Both children had an unclassified chronic inflammatory skin condition with chilblains, and recurrent mouth ulcers. One child had a chronic progressive deforming arthropathy of the small and large joints, with secondary contractures. This family illustrate the remarkable phenotypic diversity accruing from mutations in genes associated with Aicardi-Goutières syndrome (AGS). The association of arthropathy with SAMHD1 mutations highlights a phenotypic overlap of AGS with familial autoinflammatory disorders such as chronic infantile neurological cutaneous and articular syndrome (CINCA). This family therefore illustrate the need to consider mutation analysis of SAMHD1 in non-specific inflammatory phenotypes of childhood. We propose that arthropathy with progressive contractures should now be considered part of the spectrum of Aicardi-Goutières syndrome because of SAMHD1 mutations.

Neurological Manifestation of Behcet’s Disease: A Case Report

Behcet's disease causes inflammation of blood vessels but it is of unknown aetiology. When it involves the nervous system, it may present with benign headaches, aseptic meningitis, meningoencephalitis, cranial nerve palsies, seizures, personality changes, and cerebral venous thrombosis. We present the case of A.G is a 26-year old male, was a student in a Nigerian tertiary institution and resided in Lagos and Ibadan. He presented with a 2-year history of progressive and recurrent headaches, genital and mouth ulcers and weakness of the left limbs. Physical examination revealed a right handed, conscious, but apathetic and abulic young adult. All meningeal signs were positive. He had bilateral 6th nerve palsies, upper motor neuron (UMN) left 7th nerve palsy and a left partial ptosis. He had a bulbar speech with a cerebellar dysarthric twist and a grade 3 spastic left hemiparesis. However, his sensory system was intact and his presenting vital signs were within normal range. His brain computed tomogram confirmed areas of multiple infarcts, and a number of negative tests ruled out other possible differential diagnosis. He was treated for Behcet’s disease and had a dramatic positive response to antiplatelets and steroids. He was adequately stabilized on an out-patient basis, when under aunt’s care in Lagos. He, however, died following his relocation to Ibadan. An autopsy could not be done. Key Words : Behcet’s Disease, Neurological manifestations

Systemic lupus erythematosus after thymectomy for myasthenia gravis: a case report and review of the literature

Here, we report a case of systemic lupus erythematosus in a 13-year-old girl who developed the disease 3 years after thymectomy performed for the treatment of myasthenia gravis. The presenting symptoms were fever, generalized fatigability, bilateral loin pain, weight loss, arthralgia, hair loss, and recurrent painless mouth ulcers. Laboratory findings revealed proteinuria, hematuria, anemia, leucopenia, a high titer of antinuclear antibodies (ANA), anti-dsDNA, and decreased complement (C3 and C4) levels. There was minimal ascitis and pericardial effusion. Renal biopsy showed lupus nephritis class IV. The diagnosis of systemic lupus erythematosus was established based on the clinical and laboratory findings. The activity of systemic lupus erythematosus was controlled by pulsed treatment with methyl prednisolone followed by long-term oral glucocorticoid and immunosuppressive therapy. This study highlights the immune system derangement following thymectomy. It also examines the relevant literature.

Haploinsufficiency of the nerve growth factor beta gene in a 1p13 deleted female child with an insensitivity to pain

Pain insensitivity is mediated at the genetic level by the disruption of specific genes associated with neuronal development. Mammalian in vivo and in vitro studies have shown the nerve growth factor (NGF) gene to play an integral role in nerve maintenance and function. Pain insensitivity in humans can be attributed to hereditary sensory and autonomic neuropathies (HSAN) of which there are five classes (HSAN I - HSAN V). The human nerve growth factor beta gene (NGFB) located on chromosome 1p13.2 has been found to cause HSAN V within individuals homozygous for a point mutation in NGFB. Although heterozygotes can display a milder phenotype, this has only been observed in adults. We report a karyotypically normal 5-year-old female with developmental delay, mild facial dysmorphism, and unsteady gait. Pain and thermal insensitivity were noted as were recurrent mouth ulcers, facial flushing, recurrent episodes of increased body temperature and unexplained sweating, indicative of a sensory neuropathy with mild autonomic involvement. Array comparative genomic hybridization (aCGH) analysis revealed a de-novo deletion within chromosome 1p13 of the child involving the NGFB gene. Sequence analysis of the homologous NGFB gene identified no mutation, implying that sensory neuropathy was caused by haploinsufficiency of the NGFB gene.

P0451 MYOCARDIAL INFARCTION IN A YOUNG MAN WITH BEHCET DISEASE

Introduction Behcet’s disease is a systemic vasculitis characterized by recurrent oral and genital ulcers, cutaneous lesions,ocular,neurological and vascular manifestations.Vascular involvement affects arteries and veins,and includes thrombophlebitis,arterial obstruction and aneurysms.Arteries are less involved than veins,and coronary artery involvement seems to be rare in Behcet’s disease. Objectives: We report a case of 18-year-old man with Behcet’s disease since the age of seven,presenting with acute myocardial infarction due to occlusion of the left marginal artery. Materials & methods: The patient,from Egyptian and Lebanese parents,born on the 21/12/1991,was followed since his childhood for a chronic relapsing inflammatory disease manifesting with recurrent pericarditis,recurrent uveitis,recurrent mouth and anal aphthous and fever,and was considered to have a periodic disease with positive heterozygous mutation.He was on Colchicine 1-2mg since the age of 6 and received sometimes steroids when feeling not so well. He presented with acute chest pain on the 21/10/2008 and was treated on admission with colchicine and NSAIDS for a suspicion of pericarditis,the cardiac enzymes levels were elevated: Troponin:39.9 μg/l (Normal<0.15 μg/l),the diagnosis of myocardial infarction was considered and a treatment with 1 mg/kg per day Prednisone was started with Aspirin,and Heparin. Results: the coronary angiography revealed thrombotic occlusion of the marginal coronary artery with no other anomaly,the cardiac MRI showed a trans mural infarction of the lateral left ventricular wall.The patient had no chest pain on day 2 and the Troponin level decreased to 3.8μg/l on day 7 of treatment,3 months later the patient is very well with no symptoms,on 10 mg/d prednisone, associated with Aspirin and an ACE inhibitor. Discussion & conclusion: The diagnosis of Behcet’s disease was realized upon the history of the patient and the manifestations of his disease which fulfilled criterion for the diagnosis,(recurrent bipolar ulcerations, recurrent uveitis,orchitis,and recurrent pericarditis).Arterial involvement in Behcet’s disease seems to be rare estimated as 7%,manifesting as thrombosis,stenosis,and/or aneurysms.Cardiac involvement is rare,can manifest as granulomatosis endocarditis, myocarditis,arrhythmias,pericarditis.Coronary artery disease with myocardial infarction in Behcet’s disease was found by reviewing the literature in about 26 cases, many with normal coronary arteries on coronary angiography.We present a review of the literature of coronary artery involvement with myocardial infarction in Behcet’s disesase.