Morbus Behçet oder chronisch-entzündliche Darmerkrankung – ein diagnostisches und therapeutisches Dilemma

Zusammenfassung

Wir berichten über einen 43-jährigen kaukasischen Mann mit einer initial als Colitis ulcerosa eingeordneten Erkrankung. Während des 2-jährigen Krankheitsverlaufs wurden mit nur geringem Erfolg und z. T. schwerwiegenden Komplikationen Azathioprin und anti-TNF-alpha-Antikörper eingesetzt. Bei Auftreten einer komplexen Begleitsymptomatik aus oralen und skrotalen Ulzerationen, Arthritiden und verletzungsassoziierten Hautläsionen wurde erstmals die Differenzialdiagnose eines Morbus Adamantiades-Behçet mit intestinaler Beteiligung erwogen. Nach Einleitung einer parenteralen Ciclosporingabe und im Verlauf Umstellung auf Tacrolimus und Azathioprin konnte eine mehrmonatige Remission erreicht werden. Ein therapieassoziiertes akutes Nierenversagen machte schließlich die Einstellung auf Golimumab notwendig, unter der sich zunächst eine verzögerte, dann jedoch deutliche Befundbesserung einstellte.

Die Abgrenzung des Morbus Adamantiades-Behçet von CED mit extraintestinalen Manifestationen ist von besonderer Schwierigkeit, bedarf der interdisziplinären Zusammenarbeit und ist letztlich die Voraussetzung für eine erfolgreiche Therapie.

Abstract

We present the case of a 43-year old caucasian male suffering from a condition initially diagnosed as colitis ulcerosa. For 2 years Azathioprine and anti-TNF-alpha antibodies were used for treatment without convincing benefit but with serious adverse events. After the first occurrence of complex accompanying symptoms like oral and scrotal ulcerations, arthritis and scratch-induced skin lesions the differential diagnosis of a Morbus Adamantiades-Behçet with intestinal evolvement was considered. After introduction of a parenteral Ciclosporin medication, which was later switched to Tacrolimus and Azathioprin, a remission could be achieved that lasted for several months. When a drug-induced acute kidney injury occurred, the regime was changed to Golimumab and a delayed but significant improvement was achieved.

To separate Morbus Adamantiades-Behçet from inflammatory bowel disease is of some difficulty, demands interdisciplinary cooperation and is the basis for a successful therapy.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankung - chronische gastrointestinale Blutung - Morbus Crohn

Key words

inflammatory bowel disease - chronic intestinal bleeding - Crohn’s disease

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