Think Behcet's for recurrent aphthous ulcers.(Gynecology)

LAKE BUENA VISTA, FLA -- The diagnosis of Behcet's disease must be considered in any patient with recurrent oral and vulvar aphthous ulcers, even if the deep, full-thickness ulcers in the mouth and vulva develop at different times.

Behcet's disease is a chronic inflammatory vasculitis most commonly seen along the ancient silk route from Japan and across Korea, Turkey, and Greece, according to Dr. Andrew T: Goldstein. In the West it occurs most often among young women of Asian or Mediterranean descent.

"This is a bad vasculitis, with complications including dissection of the aorta, blindness, and stroke," he said.

Aside from the aphthous ulcers, patients with Behcet's disease may have acnelike skin lesions or erythema nodosum as well as ocular, central nervous system, and bowel involvement.

The ocular manifestations can be varied and severe, and include iritis, uveitis, and retinal vasculitis. Behcet's disease also can be associated with arthritis and meningitis, and any evidence of this disorder should prompt consultations with ophthalmologists, rheumatologists, and gastroenterologists as symptoms dictate.

"One of the easiest ways of diagnosing Behcet's is the pathergy test," said Dr. Goldstein, who is in group practice in Washington.

The pathergy test, in which a 5- to 7-gauge needle is inserted into the forearm, has a very high predictive value, although its negative predictive value is less. If induration develops 24-48 hours later at the site of needle insertion, the test is positive, he said at the annual meeting of the International Pelvic Pain Society.