Behcet氏症併發肱動脈瘤破裂一病例報告

Brachial Artery Aneurysm Rupture in a Patient with Behcets Disease: Report of a case

Behcet氏症為少見之全身性疾病，好發於20至40歲間，以反覆性口腔，陰部潰瘍，眼睛及皮膚發炎表現為主，血管性病灶則以靜脈炎及大血管動脈炎表現居多，在Behcet氏症雖不常見，但為極重要之表徵，嚴重者可導致動脈瘤，血管栓塞及缺血性阻塞，少數可引起死亡，其中動脈侵犯較為少見，而動脈瘤則僅散見於少數病例報告。我們報告一Behcet症併發左側肱動脈瘤破裂病例，病人為35歲男性，自訴有反覆性口腔及陰部疼痛潰瘍，下肢出現紅斑及硬塊腫痛，發燒及偶發下肢紅腫約二十多年，病人都在私人診所被當做感染治療。病人因右上臂腫痛及右下臂麻木約兩星期而住院。理學檢查發現右上臂有一4x6x18公分壓痛腫塊及下臂脈搏缺損，上唇和陰囊皮膚潰瘍，兩踝關節腫脹壓痛，左腿有紅斑性結節樣硬塊及膿皰，胸壁亦有多處紅色丘疹。Pathergy皮膚試驗呈陽性。異常實驗室檢查包括：白血球14700/cum，紅血球沉降速率58mm/hr, IgG 2010 mg/dl，電腦斷層掃描及血管攝影證實為肱動脈瘤破裂出血，病人接受大範圍切除及隱靜脈繞道手術。手術後病人接受秋水仙素和局部四環素與類固醇治療。經半年追蹤，口腔，陰部及皮膚病灶明顯改善，且無血管病變復發之跡象。

Vascular lesion including phlebitis and large vessel arteritis is less common but important feature of Bechcet's syndrome. They result in aneurysm, thrombosis, ischemic occlusion, and even death in severe cases. In this report, we present a young wale with Behcet's disease who had large aneuiysm of left brachial arteiy with rupture confirmed by computed tomographic scanning and angiography. He received surgical excision of the hematoma and a saphenous vein bypass and discharged in a stable condition.