Behçet disease — SCE Dermatology MCQ

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HardGenito-urinary disorders and oral medicineBehçet diseaseSCE Dermatology

A 32-year-old man has recurrent painful oral aphthae, genital ulcers that scar, erythema nodosum-like lesions and an episode of anterior uveitis. He has no bowel symptoms and syphilis serology is negative. What is the most likely diagnosis?

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Correct answer: C — Behçet disease

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

A is correct. Recurrent oral aphthae, scarring genital ulcers, erythema-nodosum-like lesions and anterior uveitis form the characteristic multisystem pattern of Behçet disease. Scarring genital ulceration and ocular inflammation are particularly discriminating. Recurrent herpes simplex causes episodic vesicles or ulcers but does not unify the uveitis and erythema-nodosum-like eruption. Crohn disease can cause aphthae, erythema nodosum and uveitis, but usually has gastrointestinal or perianal features and is less characteristic of recurrent scarring genital ulcers. Reactive arthritis follows genitourinary or gastrointestinal infection and is defined by arthritis with possible ocular and mucocutaneous features. Complex aphthosis causes recurrent oral and genital aphthae without the systemic vasculitic manifestations present here. Behçet disease is therefore the best unifying diagnosis, while organ assessment remains essential because ocular, neurological and vascular involvement determines risk.

Reference: BAD-BSR Behçet living guideline 2024: https://www.bad.org.uk/living-guideline-for-managing-people-with-behcets-2024