Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation

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Methods We reported an observation of an inflammatory pseudotumor of the orbit that revealed Behçet’s disease. Results Twenty-Eight years old patient was admitted to the internal medicine department for painful edema in the right eye with headache and loss of visual acuity. Ophthalmologic examination revealed eye protrusion with conjunctival hyperemia. Orbital MRI resonance imaging revealed periorbital inflammatory thickening associated with inflammatory myositis. Behçet’s was diagnosed based on a history of recurrent oral aphthous since childhood, pseudofolliculitis, pathergy test positivity, and negativity of the rest of the etiological investigations. The evolution was spectacular with boli methylprednisolone and colchicine prescriptions. Conclusion Although the association is rare, Behçet’s disease should be included in the workup of inflammatory pseudotumors of the orbit. 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F1000Research 2024, 13 :197 ( https://doi.org/10.12688/f1000research.146248.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] Sameh Sayhi https://orcid.org/0000-0001-8774-3824 1,2 , Arij Ezzouhour Yahyaoui https://orcid.org/0009-0003-1972-3241 1,2 , Rim Dhahri 3 , [...] Nour Elhouda Guediche 1,2 , Bilel Arfaoui 2,4 , Faida Ajili 1,2 , Nadia Ben Abdelhafidh 1,2 Sameh Sayhi https://orcid.org/0000-0001-8774-3824 1,2 , Arij Ezzouhour Yahyaoui https://orcid.org/0009-0003-1972-3241 1,2 , [...] Rim Dhahri 3 , Nour Elhouda Guediche 1,2 , Bilel Arfaoui 2,4 , Faida Ajili 1,2 , Nadia Ben Abdelhafidh 1,2 PUBLISHED 20 Mar 2024 Author details Author details 1 Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunis, Tunisia 2 Autoimmune Diseases Research Unit UR17DN02, Military Hosital of Tunis, Tunis, Tunisia 3 Rheumatology Department, Military Hospital of Tunis, Tunis, Tunis, Tunisia 4 Internal Medicine, Military Hospital of Bizerte, Bizerte, Bizerte, Tunisia Sameh Sayhi Roles: Conceptualization, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing Arij Ezzouhour Yahyaoui Roles: Conceptualization, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rim Dhahri Roles: Conceptualization, Formal Analysis, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Nour Elhouda Guediche Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Bilel Arfaoui Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Faida Ajili Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Nadia Ben Abdelhafidh Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Objective To provide an original observation of Behçet’s disease, revealed by an inflammatory pseudotumor of the orbit. Methods We reported an observation of an inflammatory pseudotumor of the orbit that revealed Behçet’s disease. Results Twenty-Eight years old patient was admitted to the internal medicine department for painful edema in the right eye with headache and loss of visual acuity. Ophthalmologic examination revealed eye protrusion with conjunctival hyperemia. Orbital MRI resonance imaging revealed periorbital inflammatory thickening associated with inflammatory myositis. Behçet’s was diagnosed based on a history of recurrent oral aphthous since childhood, pseudofolliculitis, pathergy test positivity, and negativity of the rest of the etiological investigations. The evolution was spectacular with boli methylprednisolone and colchicine prescriptions. Conclusion Although the association is rare, Behçet’s disease should be included in the workup of inflammatory pseudotumors of the orbit. READ ALL READ LESS Keywords Inflammatory orbital pseudotumor, Behçet’s disease, Inflammatory diseases, Corticosteroids Corresponding Author(s) Arij Ezzouhour Yahyaoui ( [email protected] ) Close Corresponding author: Arij Ezzouhour Yahyaoui Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Sayhi S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Sayhi S, Yahyaoui AE, Dhahri R et al. Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :197 ( https://doi.org/10.12688/f1000research.146248.1 ) First published: 20 Mar 2024, 13 :197 ( https://doi.org/10.12688/f1000research.146248.1 ) Latest published: 20 Mar 2024, 13 :197 ( https://doi.org/10.12688/f1000research.146248.1 ) Introduction Behçet’s disease (BD) is a systemic vasculitis that predominantly affects males. Eye involvement is common, occurs in 28-50% of cases, and is dominated by uveitis. 1 , 2 Clinical case A 28-year-old Tunisian male patient was admitted for right orbital protrusion and edema ( Figure 1 ) with local pain and intense helmet headache lasting for 15 days before admission. Figure 1. Right orbital protrusion and edema. Ophthalmological examination of the right eye revealed a visual acuity of 2/10. A painful non-pulsatile non-reducible exophthalmia with corneal edema, Tyndall to 2 crosses in the anterior chamber with iridocorneal synechia. Examination of the left eye revealed no abnormalities. Both brain and orbital MRIs were performed using T1, T2, T2*, and Flair diffusion protocols with sagittal axial and coronal cuts with and without gadolinium injection. Brain MRI revealed no cerebral venous thrombosis. Orbital MRI revealed thickening of the right anterior orbital soft tissues along with an important inflammatory signal in the extra conal fat, which was moderately enhanced by gadolinium injection, with no intra- or extra-conal soft tissue collection. MRI also showed a discrete inflammatory signal abnormality with contrast enhancement of the right internal and upper right oblique muscles and periorbital inflammatory thickening associated with inflammatory myositis with no extension to the intra-conal or intracranial fat ( Figures 2 – 5 ). No abnormalities were observed in the rest of the structures, especially in the optic nerves. Figure 2. T1 MRI transversal plane showing important inflammatory signal in extraconal fat. Figure 3. T2 MRI transversal plane showing an important inflammatory signal, which was moderately enhanced at gadolinium injection. Figure 4. T1 MRI coronal plane showing inflammatory signal in extraconal fat. Figure 5. T2 MRI coronal plane showing an important inflammatory signal, which was moderately enhanced at gadolinium injection. Physical examination revealed a history of recurrent oral aphthous and pseudofolliculitis. The remaining examinations revealed no abnormalities. B5 HLA typing was negative, and pathergy test results were positive. The diagnosis of Behçet’s disease with inflammatory orbital pseudotumor was confirmed. A workup of the tumor was performed as follows: an ENT examination and bacterial and viral serologies. Thyroid balance, antinuclear antibodies, and tumor markers CEA – PSA, alpha FP, CA 19-9, chest radiographs, sinus, and pelvic abdominal ultrasound showed no abnormalities. Biopsy of the mass was not performed. The patient received three bolus doses of 1 g of methylprednisolone per day, each relayed with corticosteroid (1 mg/kg/day associated with colchicine at a dose of 1 mg/day). The outcome was favorable after 5 days, with regression of the local inflammatory phenomena ( Figure 6 ). Examination of the control eye showed improvement in the right visual acuity to 9/10, persistent conjunctival injection with normal eye movements, and a quiet anterior segment with a normal eye bottom. The retinal angiography results were normal. Based on both clinical and examination data improvements, we did not opt for subsequent MRI control. The patient did not relapse after 6 months of follow-up. Figure 6. Regression of local inflammatory phenomena. Discussion The idiopathic orbital inflammatory syndrome was first described by Birch and Hirschfield in 1905. It is also known as orbital pseudotumor and represents a nonspecific and nonneoplastic inflammatory process of the orbit. 3 , 4 This condition most commonly involves extraocular muscles . Less commonly, there are inflammatory changes involving the uvea , sclera , lacrimal gland, and retrobulbar soft tissue . The exact etiology is unknown. The main differential diagnosis is malignant tumor progression. 5 , 6 It represents 4.7 to 6.3% (depending on the series) of all orbital conditions. 7 We distinguished between localized and diffuse inflammatory pseudotumors of the orbit. Myositis is the most frequent orbital-localized inflammatory pseudotumor. Orbital myositis is a form of idiopathic orbital inflammation, characterized by inflammation of the external eye muscles. It may lead to proptosis, periocular pain, and diplopia. 4 – 6 The etiologies are dominated by infectious causes (Lyme disease and trichinosis), sarcoidosis, Crohn’s disease, systemic lupus, polyarteritis nodosa, rheumatoid arthritis, Wegner’s granulomatosis, and neoplastic causes. 4 , 5 , 8 Diagnosis is based on radiological, histological, and clinical data. The association between Behçet’s disease and inflammatory pseudotumor has rarely been reported, and the first observation was published in 1996, reporting an inflammatory pseudotumor of the terminal ileum in Behçet’s disease. 6 Other locations have been described: the heart, 9 brain, 10 and orbit. 11 – 13 Myositis associated with Behçet’s disease is rare. It mainly affects the skeletal muscles. 7 There are few associations between orbital myositis and Behçet’s disease, as mentioned in Table 1 . 7 , 8 , 11 , 12 – 14 It is rarely reported as an initial manifestation of Behçet’s disease, as illustrated in our case. 7 , 13 , 14 To the best of our knowledge, this is the fourth reported case of Behçet’s disease caused by an inflammatory orbital pseudotumor. Table 1. reported cases of inflammatory pseudotumor of the orbit reported in Behçet’s disease. Reference Year Age Gender Presentation as the initial manifestation Other manifestations of BD Treatment Evolution Bouomrani et al. 7 2012 37 M Yes Recurrent oral and genital ulcers Pseudofolliculitis Intravenous methylprednisolone Colchicine Improvement Jee-Hoon Roh et al. 8 2006 36 F No Recurrent oral aphtous Uveitis Erythema nodosum Positive pathergy test Intravenous methylprednisolone (1 g/day for 5 days) followed by oral prednisolone 50 mg/day Improvement Hammami et al. 11 2006 35 F No Recurrent oral and genital ulcers Pseudofolliculitis Polyarthralgia Positive pathergy test Intravenous methylprednisolone (1 g/day) for 3 days followed by oral prednisone (1 mg/kg/day) Improvement Chebbi et al. 12 2013 45 M No NA Corticosteroids Improvement Garrity et al. 16 2004 33 F No NA Oral corticosteroids, cyclophosphamide, azathioprine, cyclosporine, colchicine, and methotrexate Improvement then recurrence 6 years later in the controlateral eye Oral corticosteroids Cyclosporine that was stopped because of side effects Orbital radiotherapy Infliximab (4 mg/kg) Methotrexate Immediate relief then she developed recurrence 9 months later Methotrexate (10 mg weekly), infliximab (8 mg/kg every two months), and prednisone (20 mg) NA Shinya et al. 13 2022 32 F Yes Oral and genital ulcers Folliculitis-like skin rash Presence of ulcers at the ileum Intravenous methylprednisolone Ciclosporine Improvement Aiessa Fedrigo et al. 14 2017 26 F Yes Oral and genital ulcers Arthralgias and arthritis High dose corticosteroids Absence of improvement Botulinum toxin injection on medial rectus of right eye Brief improvement Azathioprine Absence of improvement Anti-TNF α Improvement Our patient 2023 28 M Yes Oral aphthous Pseudofolliculitis Positive pathergy test Intravenous methylprednisolon: 1 gram per day for three days Oral corticosteroid: 1 mg/kg/da Colchicine Improvement As orbital biopsies are rarely done, radiological diagnosis is sufficient. 7 Treatment is based on corticosteroids, 7 – 9 as is the case in our patient. However, it may be refractory to corticosteroid therapy. Sometimes, immunosuppressive drugs are also required. 7 , 15 The prognosis is favorable with this type of treatment, apart from some recalcitrant forms that require the use of TNF blockers. 16 Rituximab has demonstrated effectiveness in cases resistant to glucocorticoids, surgery, or radiation therapy. This finding indicates that rituximab may be a valuable treatment option for managing this condition. 17 , 18 Conclusion The association between Behçet’s disease and the inflammatory pseudotumor of the orbit is exceptional. Orbital inflammation should be considered as an ophthalmic manifestation of Behçet’s disease and treated precociously to preserve the visual prognosis. Declarations Ethics approval and consent to participate not applicable Consent for publication Written informed consent for publication has been obtained from the patient. Authors’ contributions - Dr. Sameh Sayhi: Revising the article, approval of the work, and agreeing to be held accountable. - Dr. Arij Ezzouhour Yahyaoui: Drafting and revising the article, approval of the work, and agreeing to be held accountable. - Dr. Rim Dhahri: Drafting, Approval of the work, and agreeing to be held accountable. - Dr. Nour Elhouda Guediche: Revising the article, approving the work, and agreeing to be held accountable. - Dr. Bilel Arfaoui: Revising the article, approval of the work, and agreeing to be held accountable. - Dr. Faida Ajili: Revising the article, approval of the work, and agreeing to be held accountable. - Dr. Nadia Ben Abdelhafidh: Revising the article, approving the work, and agreeing to be held accountable. Data and software availability All data underlying the results are available as part of the article and no additional source data are required. References 1. Sahli E, Gurbuz-Koz O, Sahli E, et al. : Ocular Manifestations of Behçet’s Disease. Behcet’s Disease. IntechOpen; 2017 [cité 27 févr 2024]. Publisher Full Text Reference Source 2. Zając H, Turno-Kręcicka A: Ocular Manifestations of Behçet’s Disease: An Update on Diagnostic Challenges and Disease Management. J. Clin. Med. 5 nov 2021; 10 (21): 5174. PubMed Abstract | Publisher Full Text | Free Full Text 3. Yuen SJA, Rubin PAD: Idiopathic Orbital Inflammation: Distribution, Clinical Features, and Treatment Outcome. Arch. Ophthalmol. 1 avr 2003; 121 (4): 491–499. Publisher Full Text 4. Chaudhry IA, Shamsi FA, Arat YO, et al. : Orbital Pseudotumor: Distinct Diagnostic Features and Management. Middle East Afr. J. Ophthalmol. 2008; 15 (1): 17–27. PubMed Abstract | Publisher Full Text | Free Full Text 5. Kennerdell JS, Dresner SC: The nonspecific orbital inflammatory syndromes. Surv. Ophthalmol. sept 1984; 29 (2): 93–103. Publisher Full Text 6. Scott Pretorius E, Hruban RH, Fishman EK: Inflammatory pseudotumor of the terminal ileum mimicking malignancy in a patient with Behçet’s disease CT and pathological findings. Clin. Imaging. juill 1996; 20 (3): 191–193. Publisher Full Text 7. Bouomrani S, Farah A, Bouassida N, et al. : Pseudotumeur inflammatoire de l’orbite associée à une névrite optique au cours d’une maladie de Behçet. J. Fr. Ophtalmol. juin 2012; 35 (6): 439.e1–439.e6. Publisher Full Text 8. Roh JH, Koh SB, Kim JH: Orbital Myositis in Behçet’s Disease: A Case Report with MRI Findings. Eur. Neurol. 2006; 56 (1): 44–45. PubMed Abstract | Publisher Full Text 9. Darie C, Knezinsky M, Demolombe-Rague S, et al. : Pseudotumeur cardiaque révélant une maladie de Behçet. Rev. Med. Interne. mai 2005; 26 (5): 420–424. PubMed Abstract | Publisher Full Text 10. Tuzgen S, Kaya AH, Erdincler D, et al. : Two cases of neuro-Behcet’s disease mimicking cerebral tumor. Neurol. India. sept 2003; 51 (3): 376–378. PubMed Abstract 11. Hammami S, Yahia SB, Mahjoub S, et al. : Orbital inflammation associated with Behçet’s disease. Clin. Exp. Ophthalmol. mars 2006; 34 (2): 188–190. PubMed Abstract | Publisher Full Text 12. Chebbi W, Jerbi S, Ammari W, et al. : Orbital myositis in Behçet’s disease. Joint Bone Spine. mai 2014; 81 (3): 264. PubMed Abstract | Publisher Full Text 13. Abe S, Yunoki T, Hayashi A: Orbital myositis as an initial manifestation of Behcet’s disease. Am. J. Ophthalmol. Case Rep. 25 juin 2022; 27 : 101630. PubMed Abstract | Publisher Full Text | Free Full Text 14. Fedrigo A, dos Santos TAG , Campos APB, et al. : Orbital myosits in a patient with Behçet’s disease. Rev. Bras. déc 2017; 76 : 265–267. 15. Dursun D, Akova Y, Yücel E: Myositis and scleritis associated with Behçet’s disease: an atypical presentation. Ocul. Immunol. Inflamm. 1 janv 2004; 12 (4): 329–332. PubMed Abstract | Publisher Full Text 16. Garrity JA, Coleman AW, Matteson EL, et al. : Treatment of recalcitrant idiopathic orbital inflammation (chronic orbital myositis) with infliximab. Am. J. Ophthalmol. déc 2004; 138 (6): 925–930. PubMed Abstract | Publisher Full Text 17. Fang Y, Shen B, Dai Q, et al. : Orbital inflammatory pseudotumor: new advances in diagnosis, pathogenesis, and treatment. Eur. J. Med. Res. 4 oct 2023; 28 (1): 395. Publisher Full Text 18. Suhler EB, Lim LL, Beardsley RM, et al. : RITUXIMAB THERAPY FOR REFRACTORY ORBITAL INFLAMMATION: RESULTS OF A PHASE I/II DOSE-RANGING RANDOMIZED CLINICAL TRIAL. JAMA Ophthalmol. mai 2014; 132 (5): 572–578. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 20 Mar 2024 ADD YOUR COMMENT Comment Author details Author details 1 Internal Medicine Department, Military Hospital of Tunis, Tunis, Tunis, Tunisia 2 Autoimmune Diseases Research Unit UR17DN02, Military Hosital of Tunis, Tunis, Tunisia 3 Rheumatology Department, Military Hospital of Tunis, Tunis, Tunis, Tunisia 4 Internal Medicine, Military Hospital of Bizerte, Bizerte, Bizerte, Tunisia Sameh Sayhi Roles: Conceptualization, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing Arij Ezzouhour Yahyaoui Roles: Conceptualization, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rim Dhahri Roles: Conceptualization, Formal Analysis, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Nour Elhouda Guediche Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Bilel Arfaoui Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Faida Ajili Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Nadia Ben Abdelhafidh Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 20 Mar 2024, 13:197 https://doi.org/10.12688/f1000research.146248.1 Copyright © 2024 Sayhi S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Sayhi S, Yahyaoui AE, Dhahri R et al. Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :197 ( https://doi.org/10.12688/f1000research.146248.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 20 Mar 2024 Views 0 Cite How to cite this report: Naffaa ME. Reviewer Report For: Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :197 ( https://doi.org/10.5256/f1000research.160312.r367880 ) The direct URL for this report is: https://f1000research.com/articles/13-197/v1#referee-response-367880 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 Mar 2025 Mohammad E. Naffaa , Galilee Medical Center, Nahariya, Israel Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.160312.r367880 I read with great interest the case reported by Sayhi et al. the authors reported a of inflammatory pseudotumor of the eye/orbit and tried to associate it to Behcet after their basic work up was unrevealing. Though ... Continue reading READ ALL I read with great interest the case reported by Sayhi et al. the authors reported a of inflammatory pseudotumor of the eye/orbit and tried to associate it to Behcet after their basic work up was unrevealing. Though the patient might have Behcet's, I am not sure that we can attribute the orbital pseudotumor to Behcet. ANCA was not performed, tissue biopsy was not performed and thyroid induced ophthalmopathy was not considered. Indeed, other relevant diagnoses such as ANCA associated vasculitis, IGG4 related disease. Before attributing the orbital pseudotumor to BS other relevant diagnoses should be ruled out. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Rheumatology, Behcet's syndrome, systemic sclerosis, epidemiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Naffaa ME. Reviewer Report For: Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :197 ( https://doi.org/10.5256/f1000research.160312.r367880 ) The direct URL for this report is: https://f1000research.com/articles/13-197/v1#referee-response-367880 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 20 Mar 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 20 Mar 24 read Mohammad E. Naffaa , Galilee Medical Center, Nahariya, Israel Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Naffaa M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 Mar 2025 | for Version 1 Mohammad E. Naffaa , Galilee Medical Center, Nahariya, Israel 0 Views copyright © 2025 Naffaa M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I read with great interest the case reported by Sayhi et al. the authors reported a of inflammatory pseudotumor of the eye/orbit and tried to associate it to Behcet after their basic work up was unrevealing. Though the patient might have Behcet's, I am not sure that we can attribute the orbital pseudotumor to Behcet. ANCA was not performed, tissue biopsy was not performed and thyroid induced ophthalmopathy was not considered. Indeed, other relevant diagnoses such as ANCA associated vasculitis, IGG4 related disease. Before attributing the orbital pseudotumor to BS other relevant diagnoses should be ruled out. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Rheumatology, Behcet's syndrome, systemic sclerosis, epidemiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Naffaa ME. Peer Review Report For: Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :197 ( https://doi.org/10.5256/f1000research.160312.r367880) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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