A 35-year-old woman comes to the office due to oral ulcers. She has multiple painful sores on her oral mucosa that began a few days ago. The patient had similar lesions 3 months ago that healed without scarring. In addition, she recently was evaluated by an ophthalmologist for blurred vision and was diagnosed with anterior uveitis. She has also had recurrent genital lesions requiring frequent gynecology appointments over the last year. On examination, there are visible oral ulcerations as well as scattered hyperpigmented skin lesions and tender, indurated areas on her legs. Which of the following is the most likely diagnosis?

Question

A 35-year-old woman comes to the office due to oral ulcers.  She has multiple painful sores on her oral mucosa that began a few days ago.  The patient had similar lesions 3 months ago that healed without scarring.  In addition, she recently was evaluated by an ophthalmologist for blurred vision and was diagnosed with anterior uveitis.  She has also had recurrent genital lesions requiring frequent gynecology appointments over the last year.  On examination, there are visible oral ulcerations as well as scattered hyperpigmented skin lesions and tender, indurated areas on her legs.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec25c8_d506_c3ca_bc81_8b090ce7b324_MD0003_00 This patient has characteristic features of Behçet syndrome, including recurrent painful oral and genital aphthous ulcers, uveitis, and erythema nodosum (tender red nodules usually in the pretibial area). These patients are also at high risk of vascular disease (vasculitis) with venous and arterial thrombosis. Patients may also demonstrate pathergy, an exaggerated ulcerating skin response following minor injuries (eg, needlestick). pathergy Behçet syndrome is more common in patients of Turkish, Middle Eastern, and Asian descent. The diagnosis is made based on clinical features, and laboratory evaluation is primarily directed to ruling out other disorders. Biopsy of affected tissues is not usually needed but may show a nonspecific vasculitis, often involving small or medium-sized vessels. (Choice B) Herpes simplex can cause oral and genital ulcers and uveitis. However, it typically presents as vesicles (which coalesce to form lobe-shaped ulcers) that usually recur at the same location. The combination of erythema nodosum, recurrent ulcers, and uveitis makes Behçet syndrome more likely. (Choice C) Reactive arthritis can share a number of features with Behçet syndrome, including arthritis, uveitis, and oral ulcerations. However, it usually follows an acute gastrointestinal (eg, Salmonella, Yersinia) or genitourinary (eg, Chlamydia) infection and causes subacute to chronic, rather than episodic, symptoms. (Choice D) Sarcoidosis is a systemic disease characterized by noncaseating granulomas, most commonly in the lung. It can also be associated with arthritis, uveitis, and erythema nodosum. However, it usually causes significant respiratory symptoms, and recurrent orogenital aphthous ulceration is not a typical feature. (Choice E) Systemic lupus erythematosus is a multisystem disease typically presenting with a malar rash, arthritis, and constitutional symptoms (eg, fever). Oral ulcers are a common feature, but are typically painless. Educational objective: Behçet syndrome is a multisystem inflammatory condition characterized by recurrent oral and genital ulcers. Skin and ocular involvement is common. Thrombosis is a major cause of morbidity. It is most common in patients of Turkish, Middle Eastern, and Asian descent. The diagnosis is made based on clinical features. References: Behçet's disease physiopathology: a contemporary review. (http://www.ncbi.nlm.nih.gov/pubmed/26868128)

A 35-Year-Old Woman Comes to the Office Due to Oral