Persistent fever, neck swelling, and small vessel vasculitis following tonsillectomy in a patient with Behçets disease: A case report

Abstract

Introduction. Behçets disease commonly presents with recurrent oral and genital mucocutaneous ulcerations, uveitis and various skin manifestations. Other clinical symptoms include gastrointestinal ulcerations, arthritis, venous thrombosis, arterial aneurysms and central nervous system affection. Vasculitis underlies most clinical symptoms of Behçets disease. Case presentation. We report the case of a 62-year-old European Caucasian woman with Behçets disease who presented with persistent fever and neck soft-tissue swelling, despite broad antibiotic treatment, two weeks after acute tonsillitis and a tonsillectomy. Diffuse epi- and mesopharyngeal swelling shown on a computed tomography scan of her neck and persistently elevated serum markers of inflammation initially prompted suspicion of an infectious etiology. Magnet resonance imaging of her neck and a neck tissue biopsy finally confirmed small vessel vasculitis involving skin, subcutaneous tissue and muscle. Considering the clinical presentation, past medical history and histological findings, we interpreted our patients symptoms as a flare of Behçets disease. Immunosuppressive treatment led to rapid clinical improvement. Conclusion: A patient with Behçets disease developed small vessel vasculitis of the soft tissue of her neck after tonsillitis and a tonsillectomy. Infection and surgery probably triggered a flare of Behçets disease. © 2012 Wagner et al.; licensee BioMed Central Ltd.