title: [Panuveitis with oral and genital ulcer misdiagnosed as Behcet's disease: two cases report and literature review].
abstract: Here we reported two patients who presented with panuveitis and were transferred from ophthalmologists to rheumatologists, for both the patients had oral and genital ulcers. They were misdiagnosed with Behcet's disease at first glance. Two young males presented with acute uveitis with history of recurrent oral and genital ulcers. They initially presented with symptoms and signs resembling Behcet's disease and were treated with systemic steroids with suboptimal responses. Routine laboratory test revealed syphilis and human immunodeficiency virus (HIV) infection. After treatment of penicillin and anti HIV virus therapy, the panuveitis was relived. The other patient was lost in the follow up. Recently epidemiological data indicate that syphilis and HIV infection increase, which can mimic the manifestation of Behcet's disease. Diagnosis of sexual transmitted diseases, such as HIV or syphilis needs to be ruled out in all cases that mimic the clinical feature of Behcet's disease, especially for those who had a history of high risk behaviors. Every patient should have history analysis in detail. Screening of sexual transmitted diseases, such as HIV or syphilis is important especially in those rapid progressive panuveitis. Also, other virus infections, such as cytomegalovirus, epstein-barr virus or Herpes simplex virus can cause mucosa ulcers and uveitis. CD4 T cell count is a very important marker to indicate that the patient has immunodeficiency. Erythema nodosa and pseudofolliculitis are the third common clinical manifestation in Chinese Behcet's disease patients. Rheumatologist should watch out for patients without skin involvement when making the diagnosis of Behcet's disease. Syphilis-associated uveitis usually has a good prognosis. Treatment of antibiotics can get good response, 92% uveitis can be relieved, with 67% improved vision. Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a clinically and angiographically distinct manifestation of ocular syphilis. Systemic glucocorticoid can be used in syphilis induced posterior uveitis, sleritis and optic neuritis, and it can also prevent the Hector's reaction. However, for patients diagnosed with both HIV and syphilis, regular antibiotic can not prevent relapse. So doctors need to follow up them regularly. Patients who present with uveitis, oral and genital ulcers can be easily diagnosed with Behcet's disease. Rheumatologists need to be aware of the reemergence of sexual transmitted disease. High degree of clinical suspicion can allow ophthalmologists and rheumatologists to diagnose and treat the disease early. Correct diagnoses timely can get the good treatment response, and rescue the vision. Treatment with regular antivirus and Penicillin can receive the good response, and moreover glucocorticoid can relieve the inflammation.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China.
authors.forename: L
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China.
authors.forename: Z L
authors.initials: ZL
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001528:Behcet Syndrome / Q000175:diagnosis; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000639:trends*; D019468:Disease Management; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D005837:Genitalia, Male / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D009443:Neuritis / Q000188:drug therapy / Q000209:etiology; D019226:Oral Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D015864:Panuveitis / Q000175:diagnosis / Q000209:etiology; D010406:Penicillins / Q000627:therapeutic use; D011379:Prognosis; D015423:Scleritis / Q000188:drug therapy / Q000209:etiology; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000175:diagnosis; D013256:Steroids / Q000627:therapeutic use; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014456:Ulcer / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014605:Uveitis / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control*; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D010406:Penicillins; D013256:Steroids