Behçet’s disease: recurrent ischemic stroke as an initial presentation – a case based review

Behçet’s disease (BD) is a rare systemic vasculitis that is characterized by recurrent oral and genital ulcers, uveitis, and skin lesions. Although neurological involvement is a known complication, ischemic stroke remains uncommon. Herein, we report a 37-year-old Kuwaiti woman who experienced recurrent ischemic stroke with no traditional risk factors. Imaging studies, including magnetic resonance imaging and angiography, confirmed the diagnosis of recurrent ischemic stroke and identified the underlying vasculitic changes. A detailed examination revealed a history of recurrent orogenital ulcers, leading to a diagnosis of BD. High-dose corticosteroids, azathioprine, and antiplatelet treatment were effectively used to manage her acute strokes and underlying vasculitis, thus preventing further thrombotic events. Our case report underscores the difficulties of diagnosing BD with ischemic stroke as the initial manifestation and emphasizes the importance of a multidisciplinary approach that involves rheumatologists, neurologists, and radiologists to create an effective treatment plan. Our findings also underscore the need for medical practitioners to be more knowledgeable about ischemic stroke in young patients without risk factors from endemic areas of BD, and to develop effective therapy plans. Our review of the English literature indicates that this is only the fifth report of stroke as the first presentation of BD.