Papulopustular Rash in Behçet’s Disease
A 44-year-old woman presented to the emergency department with a 1-week history of a pustular rash. The rash had initially appeared on her face and subsequently appeared on her lower legs. She also reported ankle pain and odynophagia. Further history revealed that she had had recurrent bouts of oral ulcers over the past few years. She had never had genital ulcerations. On physical examination, a papulopustular rash was noted on the patient’s face (Panel A) and lower legs. Aphthous ulcers were also seen on the inner lips and gingiva when the patient lifted her lip (Panel B). There was no uveitis or retinal vasculitis on ophthalmologic evaluation. Antinuclear antibody, antineutrophil cytoplasmic antibody, human immunodeficiency virus, syphilis, herpes simplex virus, and pregnancy tests were negative. A pathergy test was not performed. Skin biopsy of a pustular lesion on the right calf revealed focal small-vessel vasculitis. A diagnosis of probable Behçet’s disease was made according to the international criteria for Behçet’s disease. The skin manifestations of Behçet’s disease are varied and include erythema nodosum, pseudofolliculitis, acneiform nodules, and papulopustular lesions, as seen in this patient. Treatment with glucocorticoids and colchicine was initiated. At 2 months of follow-up, the rash had abated.