Prolonged fever with erythema nodosum-like lesions: Behçet's disease as a diagnostic challenge in a tropical...

Behçet's disease (BD) is a multi-system inflammatory disorder characterised by recurrent oral, genital or ocular inflammation, and may present with variable-vessel vasculitis.¹ It has a distinctive geographic distribution, with the highest prevalence along the historic Silk Road, particularly in Turkey and Iran.^{2- 4} In contrast, BD is considered rare in India, with limited epidemiological data and predominantly hospital-based series.^{5, 6} Although recurrent oral ulcers are nearly universal, systemic manifestations, including ocular, vascular, neurological and gastrointestinal involvement, vary across regions.^{2, 3} Fever is not a classic presenting symptom in mucocutaneous disease, but may occur in vascular or neuro-Behçet's, where it reflects heightened systemic inflammatory activity.⁷ Consequently, BD may masquerade as a prolonged febrile illness, particularly before characteristic features emerge. Atypical presentations may delay diagnosis, particularly in low-prevalence regions.