Emergence of Different Autoimmune Diseases Including a Behçet's disease in a Sibling After tick bites. Remarkable cure of Behcet's disease by a Combination of Antibiotics and Hydroxychloroquine

Emergence of Different Autoimmune Diseases Including a Behçet's disease in a Sibling After tick bites. Remarkable cure of Behcet's disease by a Combination of Antibiotics and Hydroxychloroquine

Article Information

Alexis Lacout^1*, Marie Mas², Pierre Yves Marcy³, Christian Perronne⁴

¹Centre de diagnostic ELSAN, Centre Médico–Chirurgical, 83 avenue Charles de Gaulle, 15000, Aurillac, France

²Clinique Convert, Médecine Générale, Service des Urgences, 62 avenue de Jasseron, 01000, Bourg en Bresse, France

³Polyclinique Les Fleurs Service Imagerie Médicale, 332 Avenue Frederic Mistral, 83190, Ollioules, France

⁴Hôpital Universitaire Raymond Poincaré (Assistance Publique – Hôpitaux de Paris), Département d’Infectiologie. Université de Versailles – Saint Quentin, Paris-Saclay

^*Corresponding Author: Alexis Lacout, Centre de diagnostic ELSAN, Centre Médico–Chirurgical, 83 avenue Charles de Gaulle, 15000, Aurillac, France

Received: 28 December 2020; Accepted: 07 January 2021; Published: 15 January 2021

Citation: Alexis Lacout, Centre de diagnostic ELSAN, Centre Médico–Chirurgical, 83 avenue Charles de Gaulle, 15000, Aurillac, France, Tel: +33 687273707, Fax: +33 471485348; E-mail: lacout.alexis@orange.fr

View / Download Pdf Share at Facebook

Abstract

We report therein the onset of three chronic diseases: Behçet's disease, fibromyalgia and rheumatoid arthritis in three sisters after tick bites. Only Behcet's disease was treated in our department. After failure of the initial treatment including colchicine and corticoids, the patient recovered within a prolonged antibiotic therapy time period of 18 months.

A 23-year-old female patient was admitted to hospital in the Infectious Diseases Department as she presented with headache, diffuse inflammatory arthromyalgia, abdominal pain and cutaneous folliculitis, and for the umpteenth time for several past years, meningeal syndrome recurrence. The physical examination was unremarkable. The biological test assessment was normal, as were the ophthalmological and cerebral MRI examinations. The patient’s HLA B5 test was negative. The upper digestive fibroscopy shown digestive ulcerations.

The diagnosis of Behçet's disease was made on the following: inflammatory arthralgias, digestive ulcerations, folliculitis lesions; recurrent bipolar aphthosis was found at patient’s interview. The patient was given prednisone 0.5 mg/kg/day and colchicine 1 mg/day. The evolution was characterized by an initial improvement of clinical symptoms followed by further iterative recurrence as soon as the corticosteroid doses were reduced. Upon resuming the interview with the patient’ s mother, clinical symptoms began at the age of 9 years old by the occurrence of a voluminous cutaneous erythema following multiple tick bites. One month later the patient presented with subacute lymphocytic meningitis, which was treated as tuberculosis meningitis without relevant bacteriological evidence.

On the same day, the patient's two sisters were also bitten by ticks. A few weeks later on, one of them developed osteomyelitis of the tibia, which was operated on. The bacteriological examination result was negative, the histological ex

Keywords

Tick; Auto-immune disease; Behçet’s disease; Antibiotic; Hydroxychloroquine

Tick articles; Auto-immune disease articles; Beh?et?s disease articles; Antibiotic articles; Hydroxychloroquine articles

Article Details

Discussion

The appearance of chronic clinical syndromes and certain autoimmune diseases occurring after tick bites raises the problem of a possible link between infectious inoculation diseases and autoimmune diseases [2]. Thus, the role of certain tick-borne microorganisms such as Borrelia, Babesia, Bartonella, Ehrlichia and Anaplasma [2-5] has been discussed in the initiation of certain autoimmune diseases such as Behçet's disease, rheumatoid arthritis and fibromyalgia [6-8].

In addition, several microorganisms such as streptococci, Mycoplasma and herpes viruses have been implicated in the pathogenesis of Behcet's disease [9-11]; and disease’s significant improvements after antistreptococcal treatment have also been reported [9,12].

This observation underlines the emergence of autoimmune diseases in three sisters within the same family that may be suggestive of a genetic predisposition.

Key Clinical Message

Tick bites seem to be a possible trigger of some autoimmune diseases by the transmission of microorganisms. The development of adequate microbiological tools (serologies, PCR) is necessary to evaluate the potential infectious part in autoimmune diseases compared to the genetic part and thus to improve the management of these diseases.

Conflict of interest:

None.

Funding:

None.

References

Donta ST. Macrolide therapy of chronic Lyme disease. Medical Science Monitor 9 (2003): PI136-142.
Singh SK, Girschick HJ. Lyme borreliosis: from infection to autoimmunity. Clinical Microbiology and Infection 10 (2004): 598-614.
Marcus LC, Steere AC, Duray PH, et al. Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis: demonstration of spirochetes in the myocardium. Annals of Internal Medicine 103 (1985): 374-376.
De Martino SJ, Carlyon JA, Fikrig E. Coinfection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis. New England Journal of Medicine 345 (2001): 150-151.
Adelson ME, Rao RV, Tilton RC, et al. Prevalence of Borrelia burgdorferi, Bartonella spp., Babesia microti, and Anaplasma phagocytophila in Ixodes scapularis ticks collected in Northern New Jersey. Journal of Clinical Microbiology 42 (2004): 2799-2801.
Petersen LR, Sweeney AH, Checko PJ, et al. Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut. The Yale Journal of Biology and Medicine 62 (1989): 253.
Onen F, Tuncer D, Akar S, et al. Seroprevalence of Borrelia burgdorferi in patients with Behçet's disease. Rheumatology International 23 (2003): 289-293.
Chary-Valckenaere I, Guillemin F, Pourel J, et al. Seroreactivity to Borrelia burgdorferi antigens in early rheumatoid arthritis: a case-control study. British Journal of Rheumatology 36 (1997): 945-949.
Kaneko F, Oyama N, Nishibu A. Streptococcal infection in the pathogenesis of Behcet's disease and clinical effects of minocycline on the disease symptoms. Yonsei Medical Journal 38 (1997): 444-454.
Zouboulis CC, Turnbull JR, Mühlradt PF. High seroprevalence of anti-Mycoplasma fermentans antibodies in patients with malignant aphthosis. The Journal of Investigative Dermatology 121 (2003): 211-212.
Tojo M, Zheng X, Yanagihori H, et al. Detection of herpes virus genomes in skin lesions from patients with Behçet's disease and other related inflammatory diseases. Acta Dermato-venereologica 83 (2003): 124-127.
Çalgüneri M, Kiraz S, Ertenli I, et al. The effect of prophylactic penicillin treatment on the course of arthritis episodes in patients with Behcet's disease. A randomized clinical trial. Arthritis & Rheumatism 39 (1996): 2062-2065.