MEDizzy - A 25-year-old woman presents with a complaint of painful

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A 25-year-old woman presents with a complaint of painful mouth ulcerations. She describes these lesions as shallow ulcers that last for 1 or 2 weeks. The ulcers have been appearing for the last 6 months. For the last 2 days, the patient has had a painful red eye. She has had no genital ulcerations, arthritis, skin rashes, or photosensitivity. On physical examination, the patient appears well-developed and in no distress. She has a temperature of 37.6°C (99.7°F), heart rate of 86 bpm, blood pressure of 126/ 72 mmHg, and respiratory rate of 16 breaths/min. Examination of the oral mucosa reveals two shallow ulcers with a yellow base on the buccal mucosa. The ophthalmologic examination is consistent with anterior uveitis. The cardiopulmonary examination is normal. She has no arthritis, but medially on the right thigh, there is a palpable cord in the saphenous vein. Laboratory studies reveal an erythrocyte sedimentation rate of 68 seconds. WBC count is 10,230/μL with a diferential of 68% polymorphonuclear cells, 28% lymphocytes, and 4% monocytes. The antinuclear antibody and anti-dsDNA antibody are negative. C3 is 89 mg/dL, and C4 is 24 mg/dL. What is the most likely diagnosis?

ExplanationBehçet’s disease is a multisystem disorder of uncertain cause that is marked by oral and genital ulcerations and ocular involvement. This disorder afects males and females equally and is more common in persons of Mediterranean, Middle Eastern, and Far Eastern descent. Approximately 50% of these persons have circulating autoantibodies to human oral mucosa. The clinical features are quite varied. The presence of recurrent aphthous ulcerations is essential for the diagnosis. Most of these patients have primarily oral ulcerations, although genital ulcerations are more specifc for the diagnosis. The ulcers are generally painful, can be shallow or deep, and last for 1 or 2 weeks. Other skin involvement may occur, including folliculitis, erythema nodosum, and vasculitis. Eye involvement is the most dreaded complication because it may progress rapidly to blindness. It often presents as panuveitis, iritis, retinal vessel occlusion, or optic neuritis. This patient also presents with superfcial venous thrombosis. Superfcial and deep venous thromboses are present in one-fourth of these patients. Neurologic involvement occurs in up to 10%. Laboratory fndings are nonspecifc with elevations in the ESR and the white blood cell count. Bullous pemphigoid is a polymorphic autoimmune subepidermal blistering disease usually seen in the elderly. Initial lesions may consist of urticarial plaques; most patients eventually display tense blisters on either normal-appearing or erythematous skin. The lesions are usually distributed over the lower abdomen, groin, and f exor surface of the extremities; oral mucosal lesions are found in some patients. Discoid lupus erythematosus is the cutaneous form of SLE and is characterized by atrophic, depigmented plaques and patches surrounded by hyperpigmentation and erythema in association with scarring and alopecia.