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Treatment of Recurrent Perforating Intestinal Ulcers with Thalidomide in Behçet's Disease

Assistant Professor, Chief of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Medical Faculty, Yüzüncü Yl University, Van, Turkey

Mehmet Cetin Kotan, MD

Assistant Professor, Department of General Surgery, Medical Faculty, Yüzüncü Yl University

Nazan Topcu, MD

Resident, Department of Internal Medicine, Medical Faculty, Yüzüncü Yl University

Irfan Bayram, MD

Assistant Professor, Department of Pathology, Medical Faculty, Yüzüncü Yl University

Hasan Arslanturk, MD

Resident, Department of General Medicine, Medical Faculty, Yüzüncü Yl University

Ahmet Gul, MD

Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

Reprints: Mehmet Sayarlioglu MD, Yüzüncü Yl Üniversitesi, Tip Fakultesi, Aratrma Hastanesi, Ic Hastaliklari A.D., Romatoloji B.D., 65200 Van, Turkey, fax 90 432 2155051, sayarli{at}hotmail.com

OBJECTIVE: To report the beneficial effects of thalidomide on recurrent perforating intestinal ulcers in a patient with Behçet's disease (BD).

CASE SUMMARY: A 24-year-old Turkish woman with BD was admitted to our hospital because of severe abdominal pain and vomiting. She had been receiving colchicine 1.5 mg/day and azathioprine 150 mg/day for treatment of BD for 2 years. During emergency laparatomy, 2 perforating ulcers were detected in the anterior cecum, which were treated with debridement and primary repair. She experienced 2 more episodes of intestinal perforations during the second and fifth weeks despite intense immunosuppressive treatment with methylprednisolone and cyclophosphamide. New intestinal perforations were found in the posterolateral cecum and transverse colon during the second operation and in the terminal ileum during the third one. Thalidomide 100 mg/day was then started, and the symptoms disappeared within 2 weeks. The woman experienced no other intestinal perforation during the follow-up period of 4 months.

DISCUSSION: The mode of action of thalidomide in BD is still unclear. In BD, various cytokines have been shown to be abnormally expressed and neutrophils are overactive. This is a possible mechanism of action with thalidomide reducing both tumor necrosis factor and the neutrophil migration.

CONCLUSIONS: Thalidomide may be an effective alternative treatment for BD patients with recurrent and perforating intestinal ulcers despite intense immunosuppressive therapy.

Key Words: Behçet's disease, thalidomide

Published Online, March 9, 2004. www.theannals.com, DOI 10.1345/aph.1D524

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