Thursday, March 31, 2011

Cedilla

You are doing telemedicine and get these pictures from patients in Turkey. Patients are 20-40 years old and have recurrent painful lesions shown above. HSV is negative. They tend to be extensive and patients can have multiple lesions. For some patients, the pain is so bad they can barely eat anything. Yet the ulcers heal by themselves within 1-3 weeks.

Some patients get genital HSV screening too because they complain about the same lesions on the scrotum and vulva; often, these even lead to scarring. When doing a thorough skin exam, there are many varied lesions which can be acneiform, papulo-vesiculo-pustular, pseudofolliculitis, nodules, erythema nodosum, superficial thrombophlebitis, pyoderma gangrenosum, erythema multiforme, and palpable purpura. If you prick the skin with a needle, a pustule-like lesion or papule may form.

Eye abnormalities are also common, involving bilateral episodic uveitis, occasionally with purulence in the anterior chamber. Rarely, neurologic involvement may cause focal deficits. Some people present with hemoptysis. Others have recurrent DVTs. Most patients have a nonerosive asymmetric nondeforming arthritis of the knees, ankles, and wrists.

Challenge: What's your diagnosis?

Image shown under Fair Use.

6 comments:

jbwpac said...

Behcet's disease

Rockstar said...

Behcet's disease.. Cool case and love the blog!

Albert said...

bechet's disease?

laura said...

Behcet's Disease?

Anonymous said...

behcet's disease

Craig Chen said...

oh wow! i did not know much about behcet's until it was suggested to us by a rheum consult :) you guys are amazing! sorry for late answer
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Cedilla

A cedilla is the hook under the letter “C” in Behcet’s disease. Behcet’s is a vasculitis characterized by oral apthous ulcers and any of various systemic manifestations including genital apthae, ocular disease, skin lesions, gastrointestinal involvement, neurologic disease, vascular disease, or arthritis. It involves vessels of all sizes on arterial and venous sides of the circulation. The test of pricking the skin with a needle is called pathergy. Hypopyon is purulence in the anterior chamber of the eye. The most common vascular lesion is a pulmonary artery aneurysm.

Sources: UpToDate; www.hopkinsvasculitis.org.