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!
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)
- ...among others
Papulo-pustular rash -
- disseminiated gonococcal infection
- 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.