NSAID overuse leading to cardiac aneurysm: Unveiling a missed diagnosis of Behçet's disease: A case report.

RATIONALE: Behçet disease (BD) is a chronic inflammatory vasculitis that primarily affects young males and is associated with severe vascular complications. Prolonged nonsteroidal anti-inflammatory drug (NSAID) use may mask early inflammatory signs, delaying diagnosis and appropriate treatment.

PATIENT CONCERNS: A 28-year-old pharmacist experienced syncope, chest pain, and leg swelling after prolonged NSAID use.

DIAGNOSES: Workup revealed a left ventricular aneurysm, deep vein thrombosis, and multiple arterial occlusions, leading to the diagnosis of BD.

INTERVENTIONS: The patient received therapeutic anticoagulation, high-dose corticosteroids, cyclophosphamide, colchicine, and later azathioprine as maintenance. Surgical interventions included left ventricular aneurysmectomy and femoropopliteal bypass.

OUTCOMES: The patient showed dramatic clinical improvement with resolution of oral ulcers, normalization of cardiac function, regression of thrombus, and improvement from New York Heart Association class IV to II at 1-month follow-up. No new thrombotic or vascular events occurred during subsequent years under maintenance immunosuppression.

LESSONS: This case underscores the life-threatening consequences of undiagnosed BD and highlights how NSAID overuse can obscure early inflammatory symptoms, delay immunosuppressive therapy, and lead to severe cardiac complications. Early recognition, cautious NSAID use, and a multidisciplinary approach are essential in managing BD-related vascular disease.