Behçet's disease physical examination

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

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

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

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

Extra-ocular movements may be abnormal
Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
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 [disease name] is usually normal.

OR

Patient is usually oriented to persons, place, and time
Altered mental status
Glasgow coma scale is ___ / 15
Clonus may be present
Hyperreflexia / hyporeflexia / areflexia
Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
Muscle rigidity
Proximal/distal muscle weakness unilaterally/bilaterally
____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
Unilateral/bilateral upper/lower extremity weakness
Unilateral/bilateral sensory loss in the upper/lower extremity
Positive straight leg raise test
Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
Positive/negative Trendelenburg sign
Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
Normal finger-to-nose test / Dysmetria
Absent/present dysdiadochokinesia (palm tapping test)

CNS involvement occurs in as many as 25% of patients and may be the most serious manifestation of disease. The immune-mediated meningoencephalitis that is most commonly seen predominantly involves the brainstem. Dural venous sinus thrombosis is less common. Findings may include meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms. The CNS lesions may have exacerbations and remissions. In some patients, 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