Not as Simple as Canker Sores

BY ​NANA P. MATSUMOTO, & DEREK MEEKS, DO​​A 16-year-old boy presented to a rural ED with a swollen jaw, painful blisters in the mouth, and earache for the past day. One week before, he had a fever with chills, sore throat, and dry coughs. He was not taking any medications, and his immunizations were up-to-date. He had a mild learning disorder but no significant past medical or surgical history.​An apthous ulcer, the most common and one of the earliest signs of Behçet's disease.The patient's vital signs were within normal limits, and his physical examination revealed anterior cervical lymphadenopathy, sinus congestion, and small erythematous vesicles in bilateral tympanic membranes. There were vesicular clusters in the oral mucosa and a few shallow ulcers in the buccal mucosa and posterior pharynx. There was no evidence of facial edema, drooling, or airway compromise.The patient was prescribed a narcotic pain reliever, and was discharged in stable condition with instructions to follow up promptly with dermatology to consider other diagnoses and treatments. Herpetic gingivostomatitis was suspected.Two days later, the patient began having dysuria, followed by the appearance of genital lesions. He was admitted to the hospital where an evaluation by an infectious disease specialist revealed painful genital lesions in the urethra, similar lesions in the esophagus per endoscopy, and bilateral conjunctival injection. The patient was diagnosed with Behçet's disease, and ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research