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Recurrent vulval ulceration: could it be Behcet's disease?

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  • 1Courtyard Clinic, St George's Hospital, London SW17 0QT, UK. sheelpatel@doctors.org.uk

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Recurrent genital ulcers unresponsive to antiviral therapy may indicate Behçet's disease, a systemic inflammatory condition. Early recognition and holistic management are crucial for patients with treatment-resistant symptoms.

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Area of Science:

  • Clinical Medicine
  • Rheumatology
  • Dermatology

Background:

  • Recurrent genital ulceration can be misdiagnosed, delaying appropriate treatment.
  • Genital herpes is a common differential diagnosis for genital ulcers, often treated empirically with antivirals.

Observation:

  • A young woman presented with a 3-year history of genital ulcers initially diagnosed as genital herpes.
  • She had received acyclovir and famciclovir without symptom relief.
  • Her presentation included aphthous oral and genital ulcers, erythema nodosum, and eye irritation.

Findings:

  • Clinical diagnosis of Behçet's disease was established based on mucocutaneous and ocular findings.
  • Behçet's disease is a multisystem inflammatory disorder characterized by recurrent oral aphthae, genital ulcers, and uveitis.

Implications:

  • Clinicians should consider Behçet's disease in patients with treatment-resistant genital ulcerations.
  • A holistic approach, integrating dermatology and ophthalmology, is essential for managing systemic inflammatory diseases like Behçet's.
  • Recognizing systemic involvement is key to accurate diagnosis and effective patient management.