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Ana Sayfa : BD and COVID-19 : Clinical experience of BD and COVID-19

Clinical experience of BD and COVID-19


This page aims to collect clinical experience of BD and COVID-19. Previous experience is always worth taking into account and may be helpful pending publication of robust scientific evidence in due course.


Please send clinical experience, however brief, to Dorian Haskard at d.haskard@imperial.ac.uk. Submissions will be reviewed within ISBD prior to inclusion on this page. 



10th Sept 2020 - Professor Jan van Laar reports from Rotterdam (Netherlands): Two new cases of Behçet’s patients with COVID-19 infections are reported from the Netherlands.

The first patient involves a 34 year old woman of Moroccan descent. She had been diagnosed with Behçet’s disease since 2019 with panuveitis, oro-genital ulcers and pustular skin lesions. Her treatment includes azathioprine and steroid applications. In the first half of August she was tested positive for COVID-19 after her husband was infected. Five days later she developed afebrile influenza-like symptoms and anosmia. Azathioprine was stopped and the symptoms subdued after two weeks and she restarted azathioprine.

The second patient is a 28 year old HLA-B51 positive Syrian male with oro-genital ulcers, cutaneous manifestations  and recurrent deep venous thromboses. He also has mild osteogenesis imperfecta with a heterozygous  COL1A1 mutation.  His treatment includes colchicine and Apremilast which was started in August 2020. Soon hereafter he developed influenza-like symptoms and was tested positively for COVID-19. Within 2 weeks all symptoms subdued and he restarted Apremilast.


22th Jun 2020 - Dr Fatma Alibaz-Oner and colleagues report from Marmara University School of Medicine (Turkey):  We have had one 1 BD patient  with COVID-19. This was a 36 years old male patient who applied to our Behçet’s Clinic due to contact with a confirmed COVID-19 positive patient. Behçet’s disease was diagnosed at the age of 23 when he presented with oro-genital ulcers, erythema nodosum-like cutaneous lesions and pathergy positivity. We have been treating him with infliximab (INF) together with azathioprine for 2 years due to refractory vascular involvement (deep venous thrombosis and pulmonary thrombosis). He achieved complete remission after infliximab treatment.  He had no other comorbidity and no smoking history. He had no symptoms from COVID-19 infection, but had positive COVID-19 PCR test. When PCR was detected positive, he was in the period between two routine INF infusions. He took 5 days of hydroxychloroquine treatment, and continued to take daily azathioprine. During the follow-up quarantine period, he did not have any symptoms. His thorax CT was normal. His second PCR test was negative just before the routine INF infusion. Therefore his INF infusion was given in the scheduled date.


19th June 2020 Professor Jenaro Graña Gil and colleagues report from Coruña (Spain): Only 2 of 55 BD patients under active follow-up have developed COVID, one of whom is included in a series of COVID in inflammatory rheumatic disease from around Spain (https://doi.org/10.1101/2020.05.11.20097808)


  • Case 1  was a 73-year-old male patient, who in 1987 (40 years old) underwent surgery for a right femoral aneurysm that was associated with Behçet syndrome due to the presence of oral aphthosis, occasional genital lesions, episodes of inflammatory colitis and previous episodes of folliculitis and superficial phlebitis. He received cyclophosphamide treatment for 6 months and then azathioprine. He had several episodes of uveitis 10 years after the aneurysm episode. He had cyclosporine treatment for 5 years. Since then, he was asymptomatic for BS and without immunosuppressive treatment but has developed osteoarthritis of the knees, ischemic heart disease with the need for coronary stents and valvuloplasty due to severe mitral regurgitation in May 2019, and primary hyperparathyroidism. in the last 10 years, he has not received any specific treatment for Behçet syndrome. He has had 2 visits per year in the monographic BS consultation and has had knee infiltrations due to osteoarthritis but has not presented any reactivation of BS. Cardiovascular disease could not be associated with an inflammatory cause and is considered arteriosclerotic. In March 2020, PCR was determined for possible family infection by SARSCOV2, which was positive on 2 occasions, although he remained oligosymptomatic at home and evolved favourably.  
  • Case 2 is a 63-year-old woman. Since the age of 35 she has frequent episodes of oral aphthous lesions. At age 40, she began with self-limited episodes of anterior uveitis with a good response to topical treatment. Since then, she also has one or two episodes a year of nodular skin lesions with a good response to non-steroidal anti-inflammatory drugs and short glucocorticoid cycles. She had short periods of treatment with cyclosporine but refuses to use immunosuppressants. She is taking 1 mg of colchicine daily. In April of this year, SARSCOV2 PCR was determined by family contact, which was positive. She did not have fever or respiratory symptoms but she did have a noticeable worsening of the oral lesions and she had inflammatory skin lesions on her feet and oropharyngeal inflammation that improved with a brief course of oral  prednisone(30mg x 3 days, 15mg x 3 days and 10mg x 3 days).

18th June 2020 – Professor Gülen Hatemi reports from Istanbul (Turkey):  The Turkish Society for Rheumatology registry has a number of BD patients with COVID, and is in the process of publishing details. As there were no patients on interferon-alpha, it would be interesting to know whether interferon may have a protective role, considering its use in COVID-19 infection in China, and the beneficial results of the RCT with interferon beta-1b, when used together with Ribavirin and Lopinavir-Ritonavir compared to Lopinavir-Ritonavir alone (Hung et al. Lancet. 2020;S0140-6736(20)31042-4).


16th  June 2020 - Professor Houman Habib reports from Tunis (Tunisia): During the last 4 months, the number of patients who have consulted us has dropped drastically for fear of being infected with COVID-19. And In addition, we did not accept non-emergency patients either in the hospital or in our outpatient clinic for 1 month and a half. So, the number of patients was low compared to the non-epidemic period. In fact, I have not seen any BD patient with COVID-19, and I can confirm that this is also the case in Tunisia as a whole.


12th June 2020 - Professor Jan van Laar reports from Rotterdam (Netherlands): A 54 year old male was admitted for 3 weeks with severe respiratory symptoms. Behçet’s disease was diagnosed at the age of 22 when he presented with oro-genital ulcers, cutaneous lesions and a positive pathergy test, with HLA-B51 positivity and superficial and deep venous thromboses. All this time he was effectively treated with local applicants, colchicine and later low doses of azathioprine. Earlier this year he was diagnosed with nasopharyngeal cancer and treated with chemo-radiation therapy. After the second course he developed fever, coughing and dyspnea and was hospitalized for impending respiratory failure. He was diagnosed with COVID-19 bilateral pneumonia and treated with antibiotics and oxygen supply. After three weeks he could be dismissed. Three out of his four resident family members were also infected.


20th April 2020 - Professor Jan van Laar reports from Rotterdam (Netherlands):  A 21 year old female was admitted with COVID-19 pneumonia. She had originally presented aged 8 with fever and oral aphthous ulcers. Later on she developed vaginal ulcers,  pustules and  neurological symptoms, and also severe condylomata and warts on the hands. She has long been treated with prednisone and Remsima six-weekly (anti-TNF alpha). She mentioned that she easily acquires upper respiratory infections, presumably viral. She did not have any known risk factors for COVID-19 complications such as cardiovascular disease or obesity. She was in hospital for 7 days and recovered fully after antibiotics and oxygen supply by nasal canula. There was no clinical evidence of thrombosis. 


March 2020 - verbatim report from an Ophthalmologist in China  "So far, we have not seen any evidence regarding the influence of immunosuppressive drugs on coronavirus infection. No uveitis visiting my department reported coronavirus infection and we have not heard coronavirus infected patients from other departments complain suffering from vision loss, thus no change of the treatment."




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