Case history
Case history #1
A 30-year-old woman presents with a 4-month history of recurrent oral and genital ulcers. She gets the oral ulcers every other week, >5 at a time, and they resolve on their own in 7-10 days. They cause discomfort and occur in the inner lips and cheeks and on her tongue. The genital ulcers are fewer in number and not always painful. She has also noticed acne on her legs and on her back, but not on her face, although she never had any facial acne as a teenager. She has also had two episodes of painful, red, round lesions on her legs. These resolved without treatment after 1 week.
Case history #2
A 28-year-old man presents with a 2-month history of eye pain and blurring of vision that has been getting worse over the last several weeks. Both of his eyes are involved. He also complains of recurrent oral and genital ulcers that have been bothering him for the last 5 months. He has had facial acne for some time, but now is getting acne on his back, upper arms, and legs.
Other presentations
Behcet syndrome may also present with gastrointestinal symptoms such as diarrhea, cramping abdominal pain, and mucosal ulcerations, especially in patients from eastern Asia and the US.[3] These are frequently confused with the symptoms of inflammatory bowel disease and are indeed similar. Colonoscopy and occasionally small-bowel imaging are usually necessary to differentiate the two conditions.
About 5% to 10% of patients have central nervous system (CNS) involvement, with parenchymal or vascular manifestations. Features of parenchymal involvement include memory impairment, mental status changes, hemiparesis, dizziness, loss of balance, seizures, cranial nerve palsies, or coma. There may also be meningeal inflammation, with signs and symptoms of meningoencephalitis, including headache, confusion, and fever.[4][5] Cerebral venous thrombosis is the most common feature of vascular CNS involvement, and is marked by benign intracranial hypertension. Arterial stenosis, thrombosis, and aneurysm formation are less common manifestations of neurovascular Behcet syndrome.[2][6]
Thrombophlebitis is associated with vascular involvement in other parts of the body, mostly in the form of aneurysms; additional workup with imaging techniques may be needed to rule out such involvement. Pulmonary aneurysms are the leading cause of death.[7]
Hypopyon, the precipitation of inflammatory cells in the anterior chamber of the eye, is virtually pathognomonic.[3]
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