Yakup ALSANCAK, Zeynep DEMİR, Muhammed Fatih KALELİ, Ahmet Seyfeddin GÜRBÜZ, Ahmet SOYLU
Journal of Emergency Medicine Case Reports - 2026;17(2):89-92
Behçet's disease (BD) is a chronic multisystem vasculitis involving arteries and veins of all sizes. Coronary artery involvement is rare but potentially life-threatening. Giant coronary artery aneurysms associated with BD are uncommon and may present with acute coronary syndrome in young patients without traditional cardiovascular risk factors. A 23-year-old man presented to the emergency department with retrosternal squeezing chest pain radiating to the neck and shoulder, worsening with inspiration and positional changes. He had a recent upper respiratory tract infection and a history of recurrent pericarditis. Electrocardiography was unremarkable, while transthoracic echocardiography demonstrated anterior and lateral wall hypokinesia, mildly reduced left ventricular ejection fraction (45%), and minimal pericardial effusion. Laboratory tests revealed elevated troponin and inflammatory markers. Coronary angiography, performed due to progressive decline in left ventricular function, showed a giant aneurysm with pseudoaneurysm formation in the proximal left anterior descending artery accompanied by severe distal stenosis, as well as a saccular aneurysm of the circumflex artery. Further evaluation revealed genital scars and a positive pathergy test, leading to the diagnosis of Behçet's disease. The patient was treated with immunosuppressive and optimal medical therapy, and surgical intervention was planned. Coronary artery aneurysm secondary to Behçet's disease should be considered in young patients presenting with chest pain and minimal cardiovascular risk factors. Early diagnosis and multidisciplinary management are crucial because coronary involvement may rapidly progress and significantly increase morbidity and mortality.
