www.irdrjournal.com Intractable & Rare Diseases Research Advance Publication P1 Budd-Chiari Syndrome in Behçet's Disease successfully managed with immunosuppressive and anticoagulant therapy: A case report and literature review Christian Mario Amodeo Oblitas 1 , Francisco Galeano-Valle 1,2,3, * , Neera Toledo-Samaniego 1 , Blanca Pinilla-Llorente 4 , Jorge Del Toro-Cervera 1,2,3 , Arturo Álvarez-Luque 5 , Alejandra García-García 1 , Pablo Demelo-Rodriguez 1,2,3,6 1 Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 2 Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; 3 Universidad Complutense de Madrid, Madrid, Spain; 4 Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 5 Vascular & Interventional Radiology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 6 Universidad CEU San Pablo, Madrid, Spain. 1. Introduction Behçet's Disease (BD) is a rare, chronic and recurrent inflammatory multisystemic condition classified as vasculitis of unknown origin that can affect any tissue of the economy (mucocutaneous, ocular, cardiovascular arterio-venous, central nervous system, gastrointestinal, joint, among others). An aberrant response of different immunological pathways in relation to triggers (infectious or environmental) in predisposed subjects has been postulated in the pathogenesis of the disease, typically the human leukocyte antigen (HLA) class I gene: HLA-B51. BD is sometimes referred to as the "Silk Summary Behçet's Disease (BD) is a rare, chronic and recurrent inflammatory multisystemic condition of unknown origin that can affect any tissue. The vascular system is involved in 5-40% of cases of BD, including venous and arterial beds and it has a relapsing course. Budd-Chiari syndrome (BCS) is a rare complication of BD with a frequency of < 5% among patients with vascular involvement and is more frequent in men (89.5%). Two clinical presentation groups of BCS related to BD have been described: the "symptomatic" form and the "silent" form. We present a case of BD in a young woman presented as symptomatic severe BCS with rapid progression of coagulopathy reaching a spontaneous INR of 1.74 and increased ascites by ultrasound control. BD was confirmed through clinical history. The patient was treated with a high-dose pulse of corticosteroids and cyclophosphamide with a strikingly favorable response in the first forty-eight hours. Although several studies have demonstrated a survival improvement with the use of transjugular intrahepatic portosystemic shunt in patients with severe BCS, it was discarded due to the lack of evidence of this procedure in patients with BD and the fact that it could trigger a vascular pathergy phenomenon. Vascular BD should be suspected in recurrent venous and/or arterial thrombosis since it is associated with high morbidity and mortality. Immunosuppressive treatment is critical for the management of vascular involvement in BD. However, the role of anticoagulation is debatable. We suggest an algorithm for the management of BCS associated with BD. Keywords: Behçet's disease, Budd-Chiari syndrome, immunosuppressants, anticoagulation, transjugular intrahepatic portosystemic shunt DOI: 10.5582/irdr.2018.01128 Case Report Advance Publication Released online in J-STAGE as advance publication February 22, 2019. *Address correspondence to: Dr. Francisco Galeano-Valle, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain. E-mail: paco.galeano.valle@gmail.com