Behçet's disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with | Patients with Behcet disease usually appear normal. Vital signs of patients with Behcet disease are usually normal. The presence of mouth sores, genital ulcers, and vision problems on physical examination are diagnostic of Behcet disease. Skin examination of patients with Behcet 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 Behcet 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 Behcet 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. | ||
The | |||
The | |||
==Physical Examination== | ==Physical Examination== | ||
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===HEENT=== | ===HEENT=== | ||
*Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, vaso-occlusive lesions | *Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, vaso-occlusive lesions | ||
**Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination[13] | **Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination[13] | ||
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**Most last 7-14 days and occur in crops | **Most last 7-14 days and occur in crops | ||
* | *Hypopyon may be observed in the anterior chamber | ||
===Neck=== | ===Neck=== | ||
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===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with Behcet disease will show the following: | * Neuromuscular examination of patients with Behcet disease will show the following: | ||
**CNS involvement occurs in 25% of the cases | |||
CNS involvement occurs in | **Immune-mediated meningoencephalitis predominantly involves the brainstem | ||
**Dural venous sinus thrombosis | |||
**Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms | |||
**Irreversible dementia ultimately results | |||
===Extremities=== | ===Extremities=== | ||
Revision as of 13:07, 24 April 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Patients with Behcet disease usually appear normal. Vital signs of patients with Behcet disease are usually normal. The presence of mouth sores, genital ulcers, and vision problems on physical examination are diagnostic of Behcet disease. Skin examination of patients with Behcet 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 Behcet 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 Behcet 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 Behcet disease is usually remarkable for: skin lesions, genital lesions, and neuromuscular complications.[1][2][3]
Appearance of the Patient
- Patients with Behcet disease usually appear normal.
Vital Signs
- Vital signs of patients with Behcet disease are usually normal.
Skin
- Skin examination of patients with Behcet 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 folliculitislike 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[13]
- 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 Behcet disease is usually normal.
Lungs
- Pulmonary examination of patients with Behcet disease is usually normal.
Heart
- Cardiovascular examination of patients with Behcet disease is usually normal.
Abdomen
Abdominal examination of patients with Behcet disease is usually normal.
Back
- Back examination of patients with Behcet disease is usually normal.
Genitourinary
- Genitourinary examination of patients with Behcet 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 Behcet disease will show the following:
- CNS involvement occurs in 25% of the cases
- Immune-mediated meningoencephalitis predominantly involves the brainstem
- Dural venous sinus thrombosis
- Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms
- Irreversible dementia ultimately results
Extremities
- Monoarthritis or polyarthritis
- Knees are the most commonly affected joints, followed by wrists, ankles, and elbows
- The arthritis is typically nonerosive
Gallery
Oral cavity
Genital area
References
- ↑ Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B; et al. (2003). "Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece". Clin Exp Rheumatol. 21 (4 Suppl 30): S19–26. PMID 14727454.
- ↑ Moses Alder N, Fisher M, Yazici Y (2008). "Behçet's syndrome patients have high levels of functional disability, fatigue and pain as measured by a Multi-dimensional Health Assessment Questionnaire (MDHAQ)". Clin Exp Rheumatol. 26 (4 Suppl 50): S110–3. PMID 19026127.
- ↑ "Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease". Lancet. 335 (8697): 1078–80. 1990. PMID 1970380.