3 in 1: Behçet's disease presenting as recurrent vulvar abscesses, oral ulcers, and skin pustules

Background/Purpose: Behcet's Disease (BD) is a systemic vasculitis characterized by recurrent acute inflammation with the duration and frequency of these attacks being unpredictable There is currently no data as to the epidemiology on BD in Southeast Asia Here, we discuss a 26-year-old woman from the Philippines with BD who initially presented with recurring vulvar abscesses, our approach to diagnosis and management Methods: Case report Case Presentation: A 26-year-old female sought consult at the out-patient department for year-round recurrent vulvar abscesses, oral ulcers, generalized pustules, and arthralgia Pertinent physical examination findings are as follows: a 0 3 x 0 3 cm ulcer at the superolateral labial area, 2 0 x 1 5 cm ulcer at the inferolateral border of the left hemitongue, a 3 0 x 2 0 cm non-healing ulcer at the inferolateral border of the left vulva, a 0 3 x 0 3 cm pustule at the left posterior thigh (Figure 1) A complete blood count, blood chemistry, and urinalysis revealed mild anemia An HIV 1 and 2 ELISA, rapid plasma regain test, and pathergy test were done which were all non-reactive A biopsy of the vulvar lesion was also performed to rule out malignancy and infection We diagnosed her as a case of Behcet's Disease based on the International Criteria for Behcet's Disease She was started on Colchicine 0 6 mg once daily;educated on skin, oral, and perineal hygiene On follow-up after one month, she noted resolution of her vulvar abscesses, oral ulcers, and skin pustules However, symptoms recurred in the last three months after discontinuing treatment We used telemedicine to communicate with her (our out-patient clinics were closed due to the COVID-19 pandemic and the lockdown);advising her to continue her medication Conclusion: Timely diagnosis is essential in order to minimize recurrences, provide symptomatic relief, enhance patient education and promote antimicrobial stewardship