Correspondence
More on Hepatitis C Virus and Behçet's Syndrome
N Engl J Med 1995; 333:322-323August 3, 1995
- Article
To the Editor:
Münke et al. describe a patient in whom hepatitis C developed after she had received a transfusion of coagulation factors (Feb. 9 issue).1
According to the authors, five years after the transfusion, oral and genital ulcerations, pustules on the upper part of the body, polyarthritis, conjunctivitis, and fever developed. Behçet's syndrome was diagnosed on the basis of these manifestations.
In my opinion, the diagnosis of Behçet's syndrome is inaccurate, since none of the above clinical signs are specific for this disorder.2 Oral and genital ulcerations and pustules may be a manifestation of a viral infection (such as herpes) rather than Behçet's syndrome. When associated with Behçet's syndrome, these signs appear in crops and are typically recurrent. Polyarthritis and fever are nonspecific signs and may develop during the course of any chronic disease, especially one of viral origin, as in this patient. Furthermore, the presence of conjunctivitis should have alerted the authors, because it is not a clinical sign associated with Behçet's syndrome. Uveitis and hypopyon formation accompanying other typical manifestations may be indicative of the disease.
In my opinion, the diagnosis of Behçet's syndrome in this patient is unfounded. Furthermore, the authors' statement, “Our findings suggest that Behçet's syndrome may be another HCV [hepatitis C virus]-associated autoimmune disease that can be controlled by the administration of interferon alfa-2a,” could be misleading.
2 ReferencesDavid BenEzra, M.D., Ph.D.
Hadassah University Hospital, 91120 Jerusalem, Israel1
Munke H ,Stockmann F ,Ramadori G . Possible association between Behçet's syndrome and chronic hepatitis C virus infection. N Engl J Med 1995;332:400-401
Full Text | Web of Science | Medline2
Benezra D ,Cohen E . Treatment and visual prognosis in Behçet's disease. Br J Ophthalmol 1986;70:589-592
CrossRef | Web of Science | Medline
To the Editor:
We agree with Münke et al. that interferon alfa is effective in Behçet's syndrome, as we previously reported on the basis of a controlled study.1 In that study, however, the patients had relapses when the treatment with interferon alfa-2b was withdrawn. Furthermore, we doubt that this beneficial response is mediated by its effect on HCV as the etiologic agent. We recently studied 13 patients with severe Behçet's syndrome, all of whom had peripheral or pulmonary arterial aneurysms, and tests for HCV antibodies (Abbott HCV EIA 2.0, Abbott Laboratories, North Chicago, Ill.) were negative in all the patients. We are concerned that the reported association of HCV with Behçet's syndrome may be fortuitous.
1 ReferencesVedat Hamuryudan, M.D.
Abdullah Sonsuz, M.D.
Sebahattin Yurdakul, M.D.
University of Istanbul, Istanbul, Turkey1
Hamuryudan V ,Moral F ,Yurdakul S , et al. Systemic interferon α2b treatment in Behçet's syndrome. J Rheumatol 1994;21:1098-1100
Web of Science | Medline
To the Editor:
Münke et al. claim that HCV has a pathogenic role in Behçet's syndrome. Our experience indicates otherwise. We have tested serum samples from 224 patients with Behçet's syndrome, who were seen at a Behçet's syndrome clinic between December 1993 and November 1994, for the presence of HCV antibodies (UBI HCV EIA 4.0, United Biomedical, Lake Success, N.Y.). Serum samples from 120 patients undergoing long-term hemodialysis were used as positive controls for HCV antibodies. Sixty-one of the 120 patients in the hemodialysis group (51 percent) had positive tests for anti-HCV antibodies, as compared with only 1 of the 224 patients with Behçet's syndrome (0.45 percent). This prevalence is similar to the prevalence (0.6 percent) among 1350 people in a health survey in Turkey.1 Behçet's syndrome is not associated with HCV infection, at least not in Turkey.
1 ReferencesAytekin Oguz, M.D.
Fettah Sametoglu, M.D.
Sevgi Erdogan, M.D.
Istanbul Social Security Hospital, Istanbul, Turkey1
Thomas DL ,Mahley RB ,Badur S ,Palaoglu KE ,Quinn TC . Epidemiology of hepatitis E virus infection in Turkey. Lancet 1993;341:1561-1562
CrossRef | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: BenEzra thinks that the diagnosis of Behçet's syndrome in our patient was inaccurate. Uveitis and disturbance of vision were observed only once and therefore not mentioned in our letter, but the recurrent oral and genital ulcerations, combined with skin lesions and arthralgia, justify the diagnosis of Behçet's syndrome, according to various classifications.1 Furthermore, the fact that the symptoms in our patient have been controlled with interferon alfa-2a but were poorly controlled with immunosuppressive therapy is noteworthy.
Using a test for HCV antibodies, Oguz et al. found that Behçet's syndrome in Turkey is not associated with chronic HCV infection. This result is supported by the findings of Hamuryudan et al. However, assessment by the polymerase chain reaction is necessary before prior HCV infection can be ruled out.
1 ReferencesHans Münke, M.D.
Giuliano Ramadori, M.D.
Georg-August-Universität Göttingen, 37075 Göttingen, Germany- Citing Articles (7)
Citing Articles
1
Gulen Hatemi, Hasan Yazici. (2011) Behçet’s syndrome and micro-organisms. Best Practice & Research Clinical Rheumatology 25:3, 389-406
CrossRef2
M Carrozzo. (2008) Oral diseases associated with hepatitis C virus infection. Part 2: lichen planus and other diseases. Oral Diseases 14:3, 217-228
CrossRef3
Tadeu Ferreira Paiva, Henrique Barbosa Ribeiro, Cristiano Barbosa Campanholo, Célio Roberto Gonçalves, Dawton Y. Terigoe, Branca Dias Batista Souza. (2007) Behçet’s disease associated with superior vena cava syndrome without thrombosis. Clinical Rheumatology 26:5, 804-806
CrossRef4
Emel Erkek, Ergin Ayaslioglu. (2005) HEPATITIS C VIRUS AND BEHCET's DISEASE. Journal of Gastroenterology and Hepatology 20:8, 1309-1309
CrossRef5
Nilsel Ilter, Esin Senol, Mehmet Ali Gurer, Murat Orhan Oztas. (2000) Behcet's disease and HCV infection. International Journal of Dermatology 39:5, 396-397
CrossRef6
Yusuf Bayraktar, Ersan Özaslan, David H. Van Thiel. (2000) Gastrointestinal Manifestations of Behcet's Disease. Journal of Clinical Gastroenterology 30:2, 144-154
CrossRef7
Robert W. McMurray. (1998) HEPATITIS C–ASSOCIATED AUTOIMMUNE DISORDERS. Rheumatic Disease Clinics of North America 24:2, 353-374
CrossRef
