Refractory oral ulcers

40 yr old previously healthy female presents with “resistant” herpes. She has been having oral and genital ulcers that have been treated with valacyclovir for the past 4 weeks without improvement.
The oral ulcers are without vesicles or necrotic areas. They are painful, making it difficult to eat.
Below is a photograph of her tongue.

A tzanck smear of the lesions did NOT reveal any inclusion bodies.

  • Q. What is you diagnosis?
  • A. She has Behcet’s disease.

Reference

Behçet’s Disease, Tsuyoshi Sakane, M.D., Ph.D., Mitsuhiro Takeno, M.D., Ph.D., Noboru Suzuki, M.D., Ph.D., and Goro Inaba, M.D., Ph.D.
N Engl J Med 1999; 341:1284–1291October 21, 1999DOI: 10.1056/NEJM199910213411707