**2. Observation**

We report the case of a 29-year-old woman with no history who presented with a right humeral mass of 50 mm x70mm evolving for 2 months and that has spontaneously ruptured. An axillo-humeral bypass using the basilic vein was made. The intraoperative findings were consistent with an aneurysm of the humeral artery. The axillary artery had an inflammatory aspect with a very thickened wall suggesting vasculitis, and the humeral artery downstream was narrowed.

Histological analysis of the resected lesions showed a non-specific panvascularitis. Investigations carried out postoperatively revealed recurrent bipolar aphtosis associated with a 2-year history of inflammatory arthralgia and a 2-month history of claudication of the left upper limb. Physical examination showed a mouth ulcer on the inside of the lower lip (**Figure 1**), scars of genital ulcers, pseudo folliculitis. Peripheral pulses were present, symmetrical but weak in the left upper limb. Pathergy test was positive.

Arterial Doppler objectified the patency of the left axillary, subclavian, humeral, radial and ulnar arteries which were thin with damped and demodulated spectra. A thoraco-abdominopelvic CT angiography was performed in search of other vascular lesions. It showed a saccular aneurysm of the left subclavian artery, bronchiolar micronodules, thoracic and sub-diaphragmatic lymphadenopathies, the largest of which contained central necrosis and some of which were calcified. The diagnosis of Behçet's disease with mucocutaneous and arterial involvement, associated with tuberculosis was made. Anti-tuberculous chemotherapy followed by corticosteroids and immunosuppressants (cyclophosphamide and Azathioprine), as well as colchicine, has led to an uneventful recovery without recurrence.

**103**

*Humeral Artery Aneurysm Revealing a Rare Association between Tuberculosis and Behçet's…*

Tuberculosis is an infectious disease that presents a public health problem in developing countries where it is endemic [3]. Tuberculosis continues to be a major cause of morbidity and mortality. In developed countries, there has been an upsurge in the last decade, especially among HIV carriers, immigrant population and the

Tunisia is an intermediate-endemic country with a recorded incidence of

Extra-pulmonary tuberculosis accounts for 15 to 30% of all locations [6].

signs are often seen like weight loss, anorexia and fever, but none of them is

Symptoms can be various depending on the location of the tuberculosis. General

The main cause of tuberculosis is *Mycobacterium tuberculosis*, a thin, slightly curved, aerobe bacillus. In comparison to other bacteria, M tuberculosis has a cell wall with a very high lipid content that resists staining by the usual Gram method. However, it accepts basic fuchsin dyes and is not easily discolorized even with acidalcohol; this resistance to decolorization by acid-alcohol is termed acid-fast [8]. M tuberculosis is transmitted via airborne droplet nuclei that are produced when persons with pulmonary or laryngeal tuberculosis cough, sneeze, speak, or sing [9]. Diagnosing active tuberculosis can be difficult. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation [10]. Tuberculin testing is helpful, but it is not specific, and a negative test cannot

Cultures are slow but nevertheless remain the gold standard [11]: they allow the diagnosis to be confirmed and an antibiogram to be obtained. But they are rarely

The histopathological study is the key exam to prove the diagnosis of tuberculosis

Polymerase chain reaction should be used when having a positive direct examination, in order to distinguish the bacilli of the *Mycobacterium tuberculosis* from

The treatment consists of six months of antituberculosis chemotherapy: rifampicin and isoniazid, initially supplemented by two months of pyrazinamide and

Behçet's disease is a rare but severely debilitating vasculitis. The manifestations are typically mucocutaneous with orogenital ulcers and skin lesions [13]. However,

The symptoms are variable, which can explain the delay of the diagnosis in

Sex distribution is variable. The disease is usually severe in young adult men.

Behçet's disease occurs worldwide but clusters are found mainly along the 'silk road' with highest prevalence in Turkey, Japan and Iran, and lower prevalence in

It affects people of all ages with a predilection for those aged from 20 to 40 years.

Behçet's disease can affect potentially all organ systems because of its propensity

Oral and genital ulcers are the hallmarks of the disease, seen in up to 97% and

The confirmation of diagnosis is based on appropriate clinical symptoms after

by objectifying the tuberculoid granuloma with caseous necrosis. New diagnostic tools are available today such as Quantiféron.

Ganglion, pleural, urogenital and bone sites are the most common [7].

*DOI: http://dx.doi.org/10.5772/intechopen.95465*

35/100,000 inhabitants in 2019 [5].

**3. Discussion**

elderly [4].

specific.

exclude the diagnosis.

positive in paucibacillary tuberculosis.

other atypical mycobacteria.

many other locations can be seen.

to affect all arteries and veins.

60–90% of patients, respectively [15].

exclusion of differential diagnoses.

addition to the absence of specific blood test.

North American and northern European populations [14].

ethambutol [12].

**Figure 1.** *Mouth ulcer on the inside of the lower lip.*

*Humeral Artery Aneurysm Revealing a Rare Association between Tuberculosis and Behçet's… DOI: http://dx.doi.org/10.5772/intechopen.95465*
