Behçet's disease physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Jesus Rosario Hernandez, M.D. [3]

Overview

Patients with Behçet disease usually appear normal. Vital signs of patients with Behçet disease are usually normal. The presence of mouth sores, genital ulcers, and vision problems on physical examination are diagnostic of Behçet disease. Skin examination of patients with Behçet disease shows erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks. The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation. A folliculitis like rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients. Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site. Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, and vaso-occlusive lesions. Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination. Erythematous throat with tonsillar swelling, and exudates. Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim. A white or yellow pseudomembrane covers the surface of the ulcer. The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx. Most last 7-14 days and occur in crops. Hypopyon may be observed in the anterior chamber. Genitourinary examination of patients with Behçet disease will show ulcers on the scrotum and vulva, painful and heal with scarring. Genital ulcerations tend to be deeper and larger than the oral lesions. Females can have asymptomatic ulcers. Neuromuscular examination of patients with Behçet disease will show CNS involvement in 25% of the cases. Immune-mediated meningoencephalitis predominantly involves the brainstem. Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms can be present. Irreversible dementia can occur.

Physical Examination

Physical examination of patients with Behçet disease is usually remarkable for: skin lesions, genital lesions, and neuromuscular complications.

Appearance of the Patient

• Patients with Behçet disease usually appear normal.

Vital Signs

• Vital signs of patients with Behçet disease are usually normal.

Skin

• Skin examination of patients with Behçet disease shows the following:
  • Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks
  • The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation
  • A folliculitis like rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients
  • Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site

HEENT

• Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, vaso-occlusive lesions:
  • Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination
• Erythematous throat with tonsillar swelling, and exudates:
  • Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim
  • A white or yellow pseudomembrane covers the surface of the ulcer
  • The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx
  • Most last 7-14 days and occur in crops

• Hypopyon may be observed in the anterior chamber.

Neck

• Neck examination of patients with Behçet disease is usually normal.

Lungs

• Pulmonary examination of patients with Behçet disease is usually normal.

Heart

• Cardiovascular examination of patients with Behçet disease is usually normal.

Abdomen

• Abdominal examination of patients with Behçet disease is usually normal.

Back

• Back examination of patients with Behçet disease is usually normal.

Genitourinary

• Genitourinary examination of patients with Behçet disease will show:
  • Ulcers on the scrotum and vulva, painful and heal with scarring
  • Genital ulcerations tend to be deeper and larger than the oral lesions
  • Females can have asymptomatic ulcers

Neuromuscular

• Neuromuscular examination of patients with Behçet disease will show the following:
  • CNS involvement occurs in 25% of the cases
  • Immune-mediated meningoencephalitis predominantly involves the brain stem
  • Dural venous sinus thrombosis
  • Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms
  • Irreversible dementia

Extremities

• Monoarthritis or polyarthritis
• Knees are the most commonly affected joints, followed by wrists, ankles, and elbows
• The arthritis is typically nonerosive

Gallery

Oral ulcer Source:Created by Samuel Freire da Silva, M.D. in homage to The Master And Professor Delso Bringel Calheiros

Genital ulcer Source:Created by Samuel Freire da Silva, M.D. in homage to The Master And Professor Delso Bringel Calheiros

Penile ulcer Source:Created by Samuel Freire da Silva, M.D. in homage to The Master And Professor Delso Bringel Calheiros

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Genital area

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