A 24 year-old Moroccan man residing in Spain, previously healthy and without any history of epidemiological interest, substance misuse or sexual risk, presented with fever.

During the last year he had felt febrile, predominantly in the evenings, with malaise and 4 kg weight loss. He recalled having had oral ulcers and had recently suffered a limited episode of haemoptysis.

Physical examination revealed slight cutaneous pallor, a left parasternal pansystolic murmur, 3 cm of hepatomegaly and minimal splenic enlargement.

Blood tests showed a thalassemia minor with Hb12.2 g/dl, WBC 10,770/mm3 with normal differential and platelets 287,000/mm3. ESR was 21 mm/hr. Protein electrophoresis was normal. Auto-antibodies were negative. HIV and hepatitis B and C antibodies were negative.

A chest X ray was performed (see image).

What abnormalities do you see and what is your diagnosis?

The chest X ray shows bilateral aneurysmal dilatations of the pulmonary arteries.

This lesion is characteristic of Behçet’s disease with cardiopulmonary involvement. The disease is a vasculitis that predominantly affects young men, having a higher prevalence in the Far and Middle East and in North Africa.

The presence of oral ulcers, uveitis, genital ulcers, pathergy, and erythema nodosum are common symptoms.

Cardiopulmonary involvement occurs in 1 to 7.7 % of cases, with large pulmonary aneurysms, as in the present case, and formation of mural thrombi in the right ventricle or within the aneurysmal vessels.

The mean survival after an episode of haemoptysis is 10 months.

Treatment includes immunosuppressive therapy.