Behcet's Disease

Dr. Babiarz presented a fascinating case of a young woman who presented with fevers, oligoarticular arthralgias/arthritis, painful papulo-pustular rash, and oral ulcers, who was found to have Behcet's Disease!

 Dr. Babiarz's PowerPoint highlighted the diagnostic criteria for Behcet's disease. 

Dr. Babiarz's PowerPoint highlighted the diagnostic criteria for Behcet's disease. 

In report, we split up in teams and worked through differentials for both oligoarticular arthritis and a papulo-pustular rash, then regrouped to see which diagnoses overlapped.

Oligoarticular arthritis -

  • reactive arthritis
  • infectious arthritis (gonococcal, post infectious strep, syphilis, viral including parvo virus
  • hepatitis B and C, and HIV)
  • SLE
  • Behcet's
  • sarcoid
  • drug-induced
  • ...among others

Papulo-pustular rash -

  • endocarditis
  • disseminiated gonococcal infection
  • syphilis
  • Behcet's
  • sarcoid
  • SLE
  • vasculitis
  • drug reaction
  • ... among others

The work up in our case revealed many negative tests (ANA, ENA, ANCA, anti-Jo, GC/chlamydia, HSV, RPR, hepatitis serologies, HIV, blood cultures). A biopsy was obtained which showed a neutrophilic dermatitis. Ultimately, it was felt the presentation was most consistent with Behcet's disease!

Dr. Babiarz referenced a Cochrane review, which described a study in which colchicine was combined with benzathine penicillin. This study found that the combination may prevent new attacks of arthritis compared to colchicine alone.