[Sick or made sick? Recurrent episodes of cutaneous and subcutaneous ulcers, colitis, arthralgia and hair loss... a systemic disease or iatrogenic?].
Recurrent episodes of cutaneous and subcutaneous ulcers, especially in the oral cavity, represent a high psychological and painful burden for the patient. If there in addition are symptoms of arthralgia and/or colitis, an autoimmune disease with vasculitis, particularly a Morbus Behçet has to be considered as a possible differential diagnosis. The therapy therefore would be an immunosuppressive one. Also a wide immunologic diagnostic process has to be started. Furthermore, a chronic inflammatory bowel disease has to be excluded by colonoscopic biopsy. An infectious etiology of the symptoms (viral/bacterial/parasitic) should be investigated by microbiological and laboratory tests. A thrush or a herpes-infection caused by immunosuppression (toxic or due to illness) has to be considered as a further differential diagnosis. Also a precise medical and drug history is very important because of possible toxic adverse effects. Until confirmation of a final diagnosis, only a symptomatic analgetic or antifungal or antiviral therapy in case of a positive thrush or herpes culture respectively should be initiated with respect to the very different kinds of treatment of the diseases included in the differential diagnosis.
Medizinische Universitätsklinik, Kantonsspital Aarau AG, Aarau. Katja.Woitzek@ksa.ch
Katja
K
Woitzek
Frank
F
Dusemund
Beat
B
Müller
D000328:Adult; D000505:Alopecia / Q000209:etiology* / Q000523:psychology; D018771:Arthralgia / Q000209:etiology* / Q000523:psychology; D003092:Colitis / Q000209:etiology* / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D012883:Skin Ulcer / Q000209:etiology* / Q000523:psychology; D013281:Stomatitis, Aphthous / Q000209:etiology* / Q000523:psychology