Psychiatric symptoms in neuro-behcet’s syndrome:a case report of a patient with delusions of jealousy

Introduction

Behcet’s disease is a rheumatological condition that can affect multiple systems, involves medium and large vessels, and whose pathogenesis is not fully understood. In addition to frequently seen symptoms such as oral and genital ulcers, skin lesions, and uveitis; sensorimotor dysfunction, memory difficulties, and personality changes associated with spinal cord, brainstem, basal ganglia, and periventricular white matter involvement can occur in less than 10% of cases, and such clinical manifestation is described in the literature as Neuro-Behcet’s syndrome.[1],[2] Although psychiatric symptoms related with mood disorders and anxiety are frequently seen in this condition, delusional thought content is observed relatively rarerly.[3] This case report describes a male patient previously diagnosed with Neuro-Behcet’s syndrome who presented to a psychiatric clinic with delusions of jealousy

Aims

The case report aims to contribute to the literature on psychiatric symptoms that can be seen in Neuro-Behcet’s syndrome, a condition not very common within Behcet’s disease, and especially on delusional symptoms, which are relatively rare within this condition.

Case Presentation

A 41-year-old male patient, vocational-school graduate, a hospital employee, lives in Istanbul, Turkiye with his spouse and 5 children. His first visit to the psychiatry out-patient clinic was in January 2026.

The patient, who exhibited defensive manner regarding his mental complaints, experienced progressively increasing symptoms of irritability, crying spells, ataxic gait, and dysphonic speech starting in December 2022. He was admitted to the neurology in-patient clinic in August 2022. A cranial MRI revealed a contrast-enhancing lesion extending from the right pons to the mesencephalon. Evaluations by the rheumatology and neurology clinics led to a diagnosis of Neuro-Behcet’s Syndrome, and his follow-up and treatment continued on an outpatient basis.

The patient, whose initial complaints had relatively subsided, began to declare his delusional ideation of jealousy in July 2024, including claims of a romantic relationship between his spouse and his spouse’ brother-in-law and make nonsensical phone conversations with his spouse as if someone non-existing were present, which may be hallucinatory. Following March 2025, he experienced increasingly pronounced attention and memory loss, and developed disinhibition-related complaints such as making inappropriate jokes to friends. A neuropsychiatric test revealed a frontal-type deficit.

Initial psychiatric treatment with paliperidone 3 mg/day, gradually increased to 9 mg/day during monthly follow-ups, resulted in a relatively normalization of narrow affective range observed in the first psychiatric examination, reduced defensiveness regarding his complaints, and increased the ability to share his thoughts. He reported that his thoughts about his spouse began before he received the diagnosis of Neuro-Behçet syndrome, approximately during his initial visit to the neurology clinic. However, the content of his delusional ideation changed minimally.

Discussion and Conclusions

This case report supports the scientific literature of Neuro-Behcet’s Syndrome; psychotic symptoms such as delusions and hallucinations can accompany neuropsychiatric complaints such as disinhibition, attention and memory loss, and mood disorder-related complaints such as irritability and crying spells. This study once again emphasizes the importance of multidisciplinary evaluation and treatment by neurology, rheumatology as well as psychiatry clinics in Neuro-Behcet’s Syndrome.

References

1. Urbain F, Hardy-Léger I, Adebs-Nasser G, de Menthon M, Pivert C, Mausoléo A, Laparra A, Lerolle N, Domnariu PA, Lambotte O, Denier C, Goujard C, Castro-Gordon A, Noel N. Psychiatric Symptoms and Cognitive Disorders in Behçet’s Disease: A Single-Center, Cross-Sectional Study. J Clin Med. 2023 Apr 27;12(9):3149. doi: 10.3390/jcm12093149. PMID: 37176589; PMCID: PMC10179639.
2. Peine B, Figueroa C, Robinette N. Neuro-Behcet’s syndrome: Case report and literature review. Radiol Case Rep. 2022 Jun 21;17(9):3064-3070. doi: 10.1016/j.radcr.2022.05.070. PMID: 35769120; PMCID: PMC9234539.
3. Noel N., Bernard R., Wechsler B., Resche-Rigon M., Depaz R., Le Thi Huong Boutin D., Piette J.-C., Drier A., Dormont D., Cacoub P., et al. Long-Term Outcome of Neuro-Behçet’s Disease. Arthritis Rheumatol. 2014;66:1306–1314. doi: 10.1002/art.38351.