An unusual case of Beh？et's disease presenting with postpartum ovarian iliac vein thrombosis and pulmonary embolism

Beh？et's disease (BD) is a multisystemic recurrent inflammatory disorder. First described was the characteristic triad of oral ulcerations, genital ulcerations and, ocular lesions and later additional manifestations were described, including disorders of the skin, joints, large vessels, lungs, brain, and gastrointestinal and genitourinary tracts [1]. BD strongly predisposes patients to venous and arterial thrombosis but pulmonary thromboembolism is very uncommon and it is occasionally observed in the form of deep vein thrombosis [2].We present a patient with BD who developed thrombosis of the ovarian and iliac veins complicated by pulmonary thromboembolism during the postpartum period.A 24-year-old Tunisian woman was admitted to the hospital 2 weeks after vaginal delivery with a 10-day history of pain in the right leg, right iliac fossa, and flank. In the following days, these symptoms worsened. The patient developed chest pain, tachycardia, dyspnea, and fever increasing in severity. She was unresponsive to antibiotic therapy. A detailed past medical history revealed that she had no risk factors, but had been diagnosed with BD 2 years before with recurrent oral and genital aphthous, pseudofolliculitis, and erythema nodosum in the lower extremities. Colchicine therapy had been started, but after a while the patient stopped the therapy on her own. Physical examination upon admission revealed a fever of 38.5°C. She also had oral ulcers on the lips, hypopigmented genital scars, and pseudofolliculitis. Heart sounds and bilateral lung areas were normal upon auscultation. Laboratory tests were consistent with an inflammatory condition with a high erythrocyte sedimentation rate of 130 mm in the first hour, a C reactive protein level of 78.3 mg/dl (normal range 0–5 mg/dl), a hemoglobin value of 11 g/dl and a leukocyte count of 5400/mm3 with a normal differential count. Urinalysis, and liver and kidney function were normal; antinuclear antibody tests were negative ; platelet