Adalimumab in Deep Vein Thrombosis Treatment in a Patient with Behcet Syndrome

Introduction: Venous thrombosis in Behcet syndrome is believed to result from endothelial inflammation. Treatment include glucocorticoids, immunosuppressive agent and anticoagulant.
Case presentation: A 21-year old, soldier man, presented with diffuse pain and swelling in right lower limb from one day before. Arterial pulses in involved limb were normal. Gray scale and color Doppler sonography demonstrated a diffuse deep vein thrombosis (DVT) that continued to right external iliac vein.
The patient was a known case of Behcet syndrome from four years ago (recurrent oral and genital aphthous, arthritis, positive pathergy test, without ophthalmic involvement). He was treated with low dose of prednisolone, colchicine, azathioprine and folic acid, but he experienced recurrent episodes of bimodal aphthous lesion due to inadequate compliance to take medicine.  In this time, he had a widespread   DVT, multiple oral aphthous and pseudo folliculitis lesion in arms and back. Lab data included normal CBC, serum creatinine and liver enzyme, ESR: 100mm/h, CRP: 97mg/dl, negative for tuberculosis and brucellosis. Chest and abdominopelvic CT scan were normal.
The patient was treated by high dose prednisolone (60 mg/d), colchicine (1 mg/d), warfarin (INR: 2.5) and adalimumab (CinnoRA-CinnaGen) (40 mg every other week). The patient’s symptoms were completely improved.  One month later, the dose of prednisolone began to decrease and after 6-months, warfarin was discontinued.  One year later, interval of CinnoRA was increased to 3 and then 4 weeks and at the same time, azathioprine was begun again.
Conclusion: CinnoRA may be adequate choice in thrombotic events in Behcet syndrome