Behcet's disease

Question 1

What is Behcet’s disease?

Answer 1

Complex inflammatory condition

Presentation is often with recurrent oral and genital ulcers,
- But presentation can vary a lot

Question 2

Differentials for mouth ulcers

Answer 2

Simple aphthous ulcers are very common

Inflammatory bowel disease (particularly Crohn’s disease)

Coeliac disease

Vitamin deficiency (B12, folate or iron)

Herpes simplex ulcers

Hand, foot and mouth disease (coxsackie A virus)

Squamous cell carcinoma

Behcet’s disease

Question 3

Possible presentations of Behcet’s

Answer 3

Oral ulcers + genital ulcers + anterior uveitis = Behcet’s

Mouth and genital ulcers

Skin - e.g. erythema nodosum

Eyes - e.g. anterior uveitis (also posterior uveitis, retinal vasculitis, retinal haemorrhage)

Veins - DVT, thrombophlebitis

MSK - morning stiffness, arthralgia

GI - abdo pain, diarrhoea (ulcers through GI tract)

CNS - aseptic meningitis, memory impairment, headache/migraine

Question 4

Investigations in suspected Behcet’s disease

Answer 4

Clinical diagnosis based on the features of the condition

Pathergy test - positive pathergy test is suggestive (puncture site following needle prick becomes inflamed with small pustule forming)

Question 5

Management of Behcet’s disease?

Answer 5

Refer to rheumatology for management

Options from 1st-later ish:

• Topical steroids for ulcers
• Systemic steroids
• Colchicine
• Immunosuppressants and biologics

Other specialities may be involved depending on the affected areas, for example dermatology, ophthalmology and neurology.