Atingimento Cerebeloso como Primeira Manifestação de Doença de Behçet

Behcet’s disease is a rare multisystemic vasculitis that most commonly presents with recurrent episodes of oral ulceration. However, other system involvement may be the first sign. We report a case of a 45-year-old male who presented with walking instability, loss of motor/sensory function on the upper left arm, vertigo and poor visual acuity. The magnetic resonance imaging showed an expansive lesion in the posterior fossa adjacent to the middle cerebellar peduncle. On ophthalmic examination, he presented occlusion of the inferior temporal vein. After a complete anamnesis, it was possible to establish a history of recurrent aphthous ulceration in the oral mucosa. Due to high suspicion of Behcet’s disease with neurological involvement, the patient was started on corticosteroids, with clinical, analytical and imagiologic improvement. Behcet’s disease can be very difficult to diagnose when the initial manifestation does not include the classic clinical triade of oral aphthous ulceration, genital ulcers and ocular disease.