A 35 yo M of Turkish descent presents to clinic with oral ulcers.
History & Physical Exam
Patient Reports
- Oral ulcers started about 1 year ago and have been recurring every 2-3 months since then.
- He has had one genital ulcer during this time. He is sexually active with one partner and uses barrier protection.
- He had laboratory work drawn about 4 months ago and noticed increased redness at the site of the needlestick, which persisted for about 48 hours (he notes this has been occurring since childhood).
- Does not take any medications other than occasional OTC ibuprofen for headaches.
- The ulcers have started to become more bothersome, and he would like to see if there is anything he can do to help with their recurrence.
Physical Exam
- Two ulcers in his mouth
- Vital signs are normal.
- Labs are unremarkable.
Next Steps & Treatment
- The report of pathergy would need to be verified and visualized by a physician.
- At this time, no treatment should be started until infectious etiology is ruled out.
- If no other cause is identified, consider a topical steroid (for his oral ulcers – a dexamethasone elixir, for genital ulcers – a topical steroid), and if uncontrolled or for prevention of recurrent ulcers, colchicine or apremilast can be considered.
- Rheumatology follow-up is warranted.
A 45 yo Japanese M with history of Crohn’s disease had recent colonoscopy, which revealed increasing and worsening ulcers in his colon.
Clinical Presentation & History
- Biopsy of the new ulcers revealed nonspecific inflammation with no granulomas.
- Currently on treatment with anti-TNF alpha inhibitor and had good control of his symptoms until last year.
- He has noticed occasional oral ulcers that have increased while he has been on immunosuppressives, which he attributed to his history of oral herpes.
- He was diagnosed with Crohn’s disease at 25 yo, which was confirmed with bx with granulomas.
- Persistent redness in the area of needle sticks as child and adult.
- He recently had evaluation by an ophthalmologist; diagnosed with uveitis and treated with topical eye drops
Physical Exam & Tests
- His vital signs today are normal.
- Physical exam is unremarkable.
- CBC, CMP, ESR, and CRP are all within normal limits.
Treatment
- Alternative or additional immunosuppressant if Behcet’s is active or current anti-TNF has become ineffective