09 December 2025
: Case report 
Behçet Disease and Cognitive Impairment: A Case Study of an Overlooked Symptom
Unknown etiology, Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Clinical situation which can not be reproduced for ethical reasons, Rare coexistence of disease or pathology
Caroline Evanthe Nathania
ABCDEF 1, Astuti Prodjohardjono ACDEF 2,3, Noor Alia Susianti ABCDEF 2*, Abdul Gofir DEF 2,3, Cempaka Thursina Srie Setyaningrum DEF 2,3, Kamala Kan Nur Azza EF 4,5, Ahmad Asmedi F 2,3, Sri Sutarni F 2,3
DOI: 10.12659/AJCR.949699
Am J Case Rep 2025; 26:e949699
Table 1 Clinical timeline: symptoms, investigations, treatments, and outcomes.
| Time since initial symptom onset | Symptoms/clinical events | Investigations | Treatments | Outcomes |
|---|---|---|---|---|
| Year 0 (7 years before admission) | Clinical exam by dermatologist | Topical corticosteroids | Temporary improvement in skin lesions; progression to scarring | |
| Year 1–4 | None documented | Mouthwash and topical corticosteroids (for stomatitis) | No improvement | |
| Year 4 (referred to internal medicine) | ANA-IF (positive)Skin biopsy and IHC: inflammatory infiltrate, weak IgG, strong granular IgM perivascularDiagnosis: Behçet’s Disease | Significant improvement in oral ulcers | ||
| 6 months post-BD diagnosis | Chest CT: mediastinal massBiopsy: Stage II thymoma | Referral to oncology; patient declined surgery/chemotherapy | Stable thymoma-untreated due to patient preference | |
| Year 5 | ECG: ArrhythmiaThyroid function: TSH ↓ (0.13), FT4 ↑ (1.51) → Hyperthyroidism diagnosis | Thiamazole (5 mg once daily) | Thyroid function normalized after 2 monthsSymptoms improved | |
| Year 6 | MoCA-INA: 27/30 (deficits in memory/attention)S-IQCODE: 3INA-AD8: 0Neuropsychological testing (FDS, BDS, TMT-A/B) | Donepezil (5 mg once daily)Folic acid (1 mg three times daily)Cognitive stimulation therapy | Cognitive function improved significantly over 1 year | |
| Year 7 | (Follow-up cognitive evaluation) | Brain MRI: bilateral parietal atrophy, mild white matter changesVolumetric analysis: within normal brain and hippocampal volume parameters | Continued cognitive therapy and immunosuppressants | MoCA-INA: 30/30Normal neuropsychological scoresFull independence (ADL, IADL, Barthel Index) |
| ANA-IF – ANA testing by indirect immunofluorescence; IHC – immunohistochemical; IgG – immunoglobulin G; IgM – immunoglobulin M; ECG – electrocardiography; TSH – thyroid stimulating hormone; FT4 – free thyroxine 4; MoCA-INA – Montreal Cognitive Assessment-Indonesia Version; S-IQCODE – Informant Questionnaire on Cognitive Decline in the Elderly-Short version, INA-AD 8 – Indonesian version of the AD-8; FDS – Forward Digit Span; BDS – Backward Digit Span; TMT-A – Trail Making Test-A; TMT-B – Trail Making Test-B; MRI – magnetic resonance imaging; ADL – Activities of Daily Living; IADL – Instrumental Activities of Daily Living. | ||||