Behçet Disease

A 27-year-old man from Iraq presented with a painful lesion on the left lateral aspect of his tongue of 2 weeks' duration. Genital ulcers or skin lesions were not present. The patient also complained of a low-grade fever, weight loss, and occasional episodes of left eye pain during the past several months. He denied any significant past medical history, allergies, and the use of medications or illicit drugs.

His temperature was 38.6°C (101.5°F). A 1-cm, tender, erythematous, round, superficial ulcer was noted on the left lateral tongue. Significant laboratory findings included an erythrocyte sedimentation rate of 100 mm/h. Biopsy of the oral ulcer showed inflammatory cells (mainly monocytes) and fibrinoid necrosis of the vessels. Based on the patient's constitutional symptoms and his geographic background, Gopi Rana-Mukkavilli, MD of New York City diagnosed Behet disease.

Behet disease is an autoimmune disorder that is prevalent among persons from Mediterranean regions. Manifestations of the disease may include uveitis, rashes, arthritis, phlebitis, meningoencephalitis, and recurrent genital and oral ulcers. Typically, Behet disease is chronic with recurrent remissions and exacerbations.

Treatment consists of various immunosuppressive agents; this patient was given oral azathioprine and prednisone, but his symptoms persisted.