{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:51:44Z","timestamp":1791525104421,"version":"4.3.4"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuro-Beh\u00e7et disease (NBD) is a rare but potentially disabling manifestation of Beh\u00e7et disease (BD). Its heterogeneous neurological presentation can mimic central nervous system infection, cerebrovascular disease, inflammatory demyelination or intracranial tumors, making early diagnosis difficult. Importantly, there is still limited published data on NBD from Palestine regarding presentation, diagnosis, imaging and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We describe two patients with a long history of recurrent oral and genital ulceration who were diagnosed with parenchymal Neuro-Beh\u00e7et disease (P-NBD). The first patient was a 26-year-old man with a two-week progressive headache, fever, vomiting, and blurred vision, which resembled meningitis, in whom examination showed central facial weakness, gait imbalance and pathological laughter. The second patient was a 41-year-old woman with a two-year history of gait imbalance and dysarthria who presented with three days of dizziness, horizontal nystagmus, central facial weakness, right lower-limb weakness, and a positive bilateral extensor plantar response. Laboratory testing and brain magnetic resonance imaging (MRI) were performed to exclude other differential diagnoses. Both received intravenous methylprednisolone followed by an immunosuppressive agent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The first patient had clinical and radiological improvement after corticosteroids and initiation of induction cyclophosphamide, with clinical improvement on follow-up. The second patient improved significantly on imaging after infliximab maintenance therapy. She also improved clinically, but chronic symptoms of gait imbalance and dysarthria were still present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These two cases illustrate the variable presentation of P-NBD, including a meningitis-like febrile syndrome with pathological laughter and an acute-on-chronic brainstem syndrome. In patients with recurrent oro-genital ulceration and unexplained brainstem or diencephalic neurological findings, NBD should be considered after careful exclusion of other disorders. Early diagnosis and immunosuppressive treatment can lead to substantial clinical and radiological improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1965989","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:42Z","timestamp":1791523842000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Parenchymal Neuro-Beh\u00e7et disease with heterogeneous clinical presentations: a comparative case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Alaa Naiem","family":"Zaro","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumna","family":"Alatrash","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raya N.","family":"Amro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Quds University","place":["Jerusalem, Palestine"]},{"name":"Alia Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Y.","family":"Nairoukh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Alia Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidal","family":"Itmaiza","sequence":"additional","affiliation":[{"name":"Department of Radiology, Alia Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikram","family":"Qaysia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Alia Hospital","place":["Hebron, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2024.2388693","article-title":"Behcet disease: epidemiology, classification criteria and treatment modalities","volume":"20","author":"Fazaa","year":"2024","journal-title":"Expert Rev Clin Immunol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"562","DOI":"10.3390\/medicina60040562","article-title":"Behcet's disease, pathogenesis, clinical features, and treatment approaches: a comprehensive review","volume":"60","author":"Lavalle","year":"2024","journal-title":"Med (Kaunas)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-026-07982-7","article-title":"Epidemiology and clinical features of Beh\u00e7et's disease in the Middle East and North Africa: a systematic review and meta-analysis","volume":"45","author":"Aljohani","year":"2026","journal-title":"Clin Rheumatol"},{"key":"B4","article-title":"CNS involvement in neuro-Behcet syndrome: an MR study","volume":"20","author":"Kocer","year":"1999","journal-title":"AJNR Am J Neuroradiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-026-09173-3","article-title":"Mapping neuro Behcet's disease across North Africa: a systematic review and meta analysis","volume":"69","author":"Belfeki","year":"2026","journal-title":"Clin Rev Allergy Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2543","DOI":"10.3390\/jcm14082543","article-title":"Clinical characteristics, MRI findings, disease progression, and management of neuro-Behcet's disease: a retrospective study in Lebanon","volume":"14","author":"Chamoun","year":"2025","journal-title":"J Clin Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/S1474-4422(09)70015-8","article-title":"Neuro-Behcet's disease: epidemiology, clinical characteristics, and management","volume":"8","author":"Al-Araji","year":"2009","journal-title":"Lancet Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-013-7209-3","article-title":"Diagnosis and management of neuro-Behcet's disease: international consensus recommendations","volume":"261","author":"Kalra","year":"2014","journal-title":"J Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.revmed.2024.06.007","article-title":"Neuro-Behcet's disease: a review","volume":"45","author":"Belfeki","year":"2024","journal-title":"Rev Med Interne"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/art.24642","article-title":"HLA-B51\/B5 and the risk of Behcet's disease: a systematic review and meta-analysis of case-control genetic association studies","volume":"61","author":"de Menthon","year":"2009","journal-title":"Arthritis Rheum"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106638","article-title":"MRI findings in neuro-Behcet's disease. 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