Giant Aortic Aneurysm in Refractory Behçet's Disease Shrank with Tocilizumab Treatment: A Case Report.

Abstract

Behçet disease (BD) is characterized by recurrent oral and genital ulcers, skin lesions, and vascular involvement. Giant aortic aneurysm, a life-threatening complication of BD, often proves refractory to conventional therapies. Here, we present the case of a 71-year-old man with a 40-year history of BD complicated by a giant aortic aneurysm, which was successfully managed using the interleukin-6 (IL-6) receptor antagonist tocilizumab (TCZ). Despite years of tight treatment with high-dose glucocorticoids and immunosuppressants, there were frequent flares of disease and aortic aneurysm formation. Following the initiation of TCZ therapy, the patient achieved remarkable clinical improvement: the aortic aneurysm diameter decreased significantly from 10.15 × 7.83 cm to 6.22 × 5.12 cm, and disease activity, as measured by the Behçet's Disease Current Activity Form score, dropped from 8 to 1, indicating sustained disease control. This case underscores the potential of IL-6 inhibition as a transformative therapeutic strategy for refractory BD with severe vascular complications, offering new hope for patients with this challenging condition.