Intestinal Behçet's disease presenting with intestinal obstruction misdiagnosed as Crohn's disease: a case report

Diagnostic dilemmas persist as intestinal Behçet's disease mirrors Crohn's disease with significant overlap in clinical, endoscopic, and pathological features, with up to 30% of patients lacking classic extraintestinal manifestations.

A 45-year-old Chinese male patient was admitted with postprandial abdominal distension and borborygmi for over 1 month, without a history of oral or genital ulcers or other related conditions. Contrast-enhanced abdominal computed tomography demonstrated ileocecal wall thickening with mesenteric lymphadenopathy, while small bowel endoscopy revealed multiple ileal ulcers and relative stenosis of the intestinal lumen. Owing to the tendency for intestinal obstruction, surgical intervention was performed. Pathological findings initially suggested Crohn's disease. Postoperative anti-inflammatory therapy and nutritional support partially alleviated symptoms, but intermittent abdominal distension persisted. After expert histopathological review by a higher-level institution, the diagnosis was corrected to intestinal Behçet's disease, with subsequent initiation of thalidomide treatment daily.

Given the strong resemblance between intestinal Behçet's disease and Crohn's disease, especially in the absence of typical extraintestinal manifestation, differentiation requires comprehensive endoscopic evaluation and systematic histopathological examination. Although the specific treatment regimen remains controversial, early diagnosis and timely initiation of medical therapy are crucial for improving prognosis.