Behet Disease- Physical Exam

1. Skin:

Pseudofolliculitis and acneiform lesions, found more commonly in males

with Behet disease, primarily affect the trunk and extremities
Erythema nodosum, which is more common in females with the disease,
are occasionally differentiated from alternate etiologies based on
ulceration, which is a characteristic more unique to Behet disease

2. Oral cavity:
Oral lesions represent the most common, and often the first, manifestation of
Behet disease. Even when they are not the first manifestation, they are
considered a primary criterion for diagnosis and eventually occur in most
patients.
Ulcers are aphthous or herpetiform in nature and can occur in various
keratinized areas of the oral cavity. They can be very painful, can last up to 3-5
weeks, and can vary in size. Large ulcers (>10 mm in diameter) heal with
scarring as do their genital counterparts.
3. Eyes:
Anterior uveitis with and without hypopyon formation
Posterior uveitis that may cause blindness
Glaucoma
Synechiae
Retinal vasculitis
Infarctions
Hemorrhage
Edematous appearance of the disc, with retinal detachment
Leaky retinal vessels revealed by fluorescein angiography, leading to
atrophy and fibrosis in some cases
4. Joints:
Arthritis of the large joints, mostly affecting the lower extremities; usually
non-deforming, non-erosive, asymmetric
5. Genital ulcers: in females, these lesions commonly appear in the labial
folds but can also be found in the vulva and vagina. In males, they are
usually scrotal in nature but can also develop in the perianal region and
penile shaft. Genital ulcers last longer than oral lesions, are deeper, and
typically scar after healing. Ulcerations in women may correlate with

menstruation.
6. Cardio-Vascular manifestations:

Venous (more common): Lower-extremity superficial thrombophlebitis

often presents in a linear fashion with overlying erythema and
tenderness. Palpation of sclerosed thrombophlebitis yields subcutaneous
string-like quality. Deep venous thrombosis (DVT) develops in some cases
and typically manifests as local tenderness or as disparity in limb girth.
Superior and inferior vena cava occlusion, Budd-Chiari syndrome, dural
sinus thrombosis, and other venous obstructive lesions can also occur

Arterial (less common): most commonly a small vessel vasculitis, but

medium and large vessel disease may also develop. Pulmonary arterial
involvement is particularly characteristic, hemoptysis is the most
common presenting symptom; cough, dyspnea, fever, and pleuritic pain
are other presenting symptoms. Pulmonary artery aneurysms
involving the large proximal branches of the pulmonary arteries are the
most common pulmonary vascular lesion in Behets and are
uncommonly seen in diseases other than Behets.

Peripheral edema: 2ndary to cardiac or renal failure (because of cardiac or

renal involvement)