An unusual cause of granulomatous colitis: Behcet's disease

Intestinal involvement in Behcet's disease (BD) is uncommon. Differentiating it from close mimics like Crohn's Disease is difficult. Further, in asymptomatic cases, diagnostic challenges posed is still greater. A 17-year-old boy had history of recurrent oro-genital ulcers, papulo-pustular skin eruptions, ocular lesions and had presented with recent onset perianal abscess. Fecal calprotectin was elevated, and ileo-colonoscopy showed ileocolonic ulcers of inflammatory nature. Clinical diagnosis of intestinal BD was made. Patients with BD having mucosal lesions may harbor asymptomatic intestinal lesions. Screening them with fecal calprotectin levels and if positive, with subsequent imaging and endoscopic biopsy with timely initiation of appropriate treatment in such asymptomatic cases help to control overall disease activity.