An unusual localisation of genital ulcer in Behçet's disease: External urethral meatus

Dear editor, Behçet's disease (BD) is a chronic, recurrent, multisystemic vasculitis which can affect all vascular system. The most common symptom is genital ulcer accompanying oral aphthae, and its diagnosis is currently made according to the International Criteria for Behçet's Disease (ICBD). Providing two points for oral aphthae, genital ulcers and ocular involvement and one point for the other skin lesions (erythema nodosum, papulopustular/acneiform lesions in postadolescent), vascular involvement and neurological findings are evaluated if the patient scores reach four or more; the patient is considered to be BD.1,2 In men, genital aphthous ulcers occur in 60 to 65% of cases and are most common in the scrotum, shaft and glans penis, and rarely in the groin and perineum, extremely rare in the urethral orifice2,3 We presented a patient with a complaint of painful micturition, ultimately diagnosed with BD. A 34yearold male patient was consulted from the urology following the evaluation of his painful voiding complaint 10 days accompanying wound in the periurethral orifice. On genital examination, an oval, and sharp circumscribed aphthous ulcer with a serous floor, approximately 4 mm in diameter, was seen on the external urethral orifice (Figure 1A). The patient who had no known disease has refused to use any medication, similar complaints, suspicious sexual contact, except for oral aphthae recurring 810 times a year (Figure 1B). After noticing a few pustular lesions with peripheral partial erythema on his back, we focused on BD and inflammatory bowel diseases in the examination (Figure 1C). We learned that the patient had no family history and other related symptoms. Bowel habits were normal. Hepatitis, HIV, syphilis serologies were negative. CRP and sedimentation were 3.2 mg/dL (05 mg/dL) and 27 mm/hour (020 mm/h); respectively. Other haematological and biochemical parameters were within normal limits. Complement levels, antinuclear antibody, antidsDNA, pANCA, cANCA and rheumatoid factor were normal. Pathergy test was positive. The patient was diagnosed with BD with a score of 6 according to the current ICBD, and no pathology was found in the eye and cardiology consultations. His complaints improved within 1 week without leaving any scar, after treatment with topical betamethasone valerate applied to the urethral orifice and oral colchicine 1.5 mg/d. No clinical progression has been observed for 2 years in the followup. A urethral ulcer is an unusual finding in BD. Aktaş recently reported a 27yearold male patient with clinical features quite similar