An extraordinary manifestation of Behçet's disease in a young male: Urinary meatus ulcer.

Abstract

Behçet's disease is a chronic relapsing multisystem disorder characterized by mucocutaneous, ocular and other organ involvement. Genital aphthous ulcers are among the most commonly seen clinical features, and constitute one of the main diagnosis criteria. The most common localization of genital ulcers in men is the scrotum, nearly 90% of all lesions. Corpus penis and glans penis are other involved sites.1 Recurrent ulcers in Behçet's disease are also described in the extragenital skin, larynx and esophagus, apart from the genital area.2-4 It is extremely rare in the uretral orifice.5 In this article, we present a young male patient with a complaint of painful voiding, eventually diagnosed with Behçet's disease. A 27-year-old male patient was referred to the dermatology outpatient clinic by the urology clinic following evaluation of his painful voiding complaint. Dermatological examination revealed a clean ulcer with a diameter of 2 mm at the entrance of the urethra (Figure 1). According to the history, the patient's complaint had been present for about 5 days. The patient had no history of suspicious sexual intercourse and Venereal Disease Research Laboratory and Treponema pallidum hemagglutination tests were negative for syphilis. He had recurrent oral aphthous ulcers, emerging at least once a month for several years. There was also an acneiform rash on the back and gluteal region (Figure 2). Pathergy test was found negative. The eye consultation was normal. There were no clinical and laboratory findings related to other organ involvement. The patient was diagnosed with Behçet's disease based on these findings and was taken to follow-up. A triamcinolone ointment was recommended for the aphthous lesions. The urethral ulcer recovered within a week. The development of an ulcer at the entrance of the urethra is quite uncommon. In male patients, recurrent ulcers are usually seen in the scrotum. Corpus penis, glans penis are other common areas. The diagnosis of Behçet's disease can be skipped in patients presenting with isolated ulcerations. The patient had a history of oral aphthous ulcers and acneiform skin rashes. A meticulous questioning about the patient's clinical conditions helped to place a diagnosis of Behçet's disease. The uretral orifice is a risky site for scarring. Genital ulcers usually leave scars after healing because of their depth. In the study by Mat et al, the rate of scarring was found to be 66% in Behçet's patients with genital ulcers.6 Fortunately, our patient recovered without any sequela. Ghosh et al reported a 16-year-old boy with Behçet's disease, who had several severe oral and genital aphthous ulcers. This patient had urethral meatal stenosis due to scarring from external urethral meatus ulceration.7 Our case was not as serious as this. There is an interesting aspect because eye involvement is rarely seen rare in Behçet's patients with genital ulcers.8 Hence, eye involvement was not detected in our patient. This case report emphasizes taking a good clinical history in patients suffering from genital or extragenital ulcers to avoid skipping the diagnosis of important diseases. No conflict of interest.