Poncet's disease presenting as Pseudo-Behçet's disease

Multiple cutaneous and mucocutaneous lesions as manifestations of pseudo-Behçet's disease

Pseudo-Behçet's disease (PBD) is a close clinical mimicker of Behçet's disease (BD) which can present with orogenital ulceration and uveitis. However, these manifestations in PBD are associated with occult tuberculosis. Sometimes, diagnosis of PBD is established retrospectively when the lesions respond to anti-tubercular therapy (ATT). We here describe a case who presented with a penile ulcer, initially suspected to be a sexually transmitted infection, but was later diagnosed as PBD and resulted in complete healing with ATT. Knowledge about this condition is essential to prevent misdiagnosis as BD and unnecessary treatment with systemic corticosteroids, which can lead to worsening of tuberculosis.

Uveitis developing in tuberculous lymphadenitis-associated Behçet's disease during anti-tuberculosis therapy

Behçet's disease (BD) is thought to be elicited by triggers such as tuberculosis (TB) infection in individuals with genetically aberrant immune activity, although the exact pathogenesis remains unknown. Seven cases of BD thought to be triggered by TB have been reported to date. In all cases, Behçet's symptoms improved smoothly after starting TB treatment. We present the first report of uveitis developing two months after starting TB treatment in a 46-year-old woman with tuberculous lymphadenitis presenting with oral and genital ulcers and erythema nodosum-like lesions on diagnosis of TB. The appearance of uveitis was attributed to a paradoxical reaction in TB because of simultaneous relapse of lymphadenopathy and retinal findings on fluorescein angiography. Although rare, physicians should be aware that ocular involvement can occur during anti-TB therapy, most likely with extrapulmonary TB, because ocular involvement may decrease patient quality of life if visual symptoms become irreversible with delayed diagnosis and treatment.