Acute Febrile Polyarthritis Revealing very Late-Onset Behcet's Disease

Introduction: Late-onset forms of Behçet’s disease (BD), by definition after the age of 40, remain rare and highly controversial. The revelation of these forms by articular manifestations is not uncommon and poses a real diagnostic challenge; particularly in elderly. We report an original observation of acute febrile polyarthritis revealing a very late-onset BD.

Case Report: A 65-year-old patient with simple and well-balanced primary hypertension under combination therapy with a beta blocker and an angiotensin-converting enzyme inhibitor, was hospitalized for etiological assessment of acute and febrile polyarthritis affecting hands, wrists, knees and ankles, evolving for two weeks with fever at 38°C.

The examination noted multiple oral aphtosis, genital ulcers and scares, and pseudo-folliculitis at the inner sides of the thighs and back.

The infectious, radiological and immunological assessments were negative, eliminating particularly infections, endocarditis, lupus, ANCA-associatedangiitis, spondylarthropathies, and rheumatoid arthritis. The Pathergy-test and HLA B51 typing were positive.

The diagnosis of BD was retained in accordance with the new international criteria for BD and the patient was placed on Colchicine®, Aspégic® and low dose oral corticosteroids with a favorable evolution.

Conclusion: The maximum incidence of BD is observed between the second and fourth decade of life. Late-onset forms of BD are rare and very late-onset forms are exceptional and uncommon. As rare as it is, BD deserves to be mentioned in front of any arthritis that is not proven, occurring in a geriatric environment.

Keywords: Acute polyarthritis, late-onset, Behçet’s disease, arthritis, vasculitis, elderly.