A Rare Presentation of Behçet's Disease: Coexistence of Intracardiac Thrombi, Coronary Artery Disease, and Pulmonary Thromboembolism.

Abstract

Behçet's disease (BD) is a rare systemic vasculitis. While pulmonary involvement occurs, severe intracardiac manifestations are exceptional. We report a 44-year-old male presenting with dyspnea and hemoptysis. Multimodality imaging revealed bilateral pulmonary thromboembolism, severe three-vessel and left main coronary artery disease, alongside massive thrombi on the ventricular surface of the tricuspid valve (right ventricle) and at the left ventricular apex. With negative blood cultures, he was diagnosed with BD. Refusing recommended surgical revascularization, he was successfully managed with immunosuppressants (glucocorticoids, cyclophosphamide, infliximab), rivaroxaban, and heart failure therapies. This case underscores the critical role of echocardiography and multimodality imaging in diagnosing life-threatening, multi-system cardiovascular complications of BD.