Ciclosporin-associated cerebral tumor-like location of Behçet's disease

Cerebral tumor-like location is uncommon in the course of Behçet's disease. We report herein a patient with tumor-like lesions associated with ciclosporin therapy. A 45-year-old male treated for 17 years with colchicine and ciclosporin for Behçet's disease with cutaneomucosal, ocular and joint involvement was admitted for sudden onset of meningo-encephalitis with lymphocytic meningitis. CT-scan showed a nodular lesion of the brainstem enhanced by iodine. Ciclosporin was discontinued; prednisone and IV cyclophosphamide were started. After three months of favorable outcome, a relapse occurred when ciclosporin was started again. MRI showed two additional capsulothalamic lesions. Prednisone and cyclophosphamide were started again with a favorable response and minimal sequelae. The main challenge in cerebral tumor-like location of Behçet's disease is to rule out other inflammatory or tumor processes. Neuronal toxicity of ciclosporin limits indications for this therapy in Behçet's disease.