Behçet's disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with Behcet disease usually appear normal. Vital signs of patients with Behcet disease are usually normal. The presence of mouth sores, genital ulcers, and vision problems on physical examination are diagnostic of Behcet disease. Skin examination of patients with Behcet disease shows erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks. The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation. A folliculitis like rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients. Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site. Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, and vaso-occlusive lesions. Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination. Erythematous throat with tonsillar swelling, and exudates. Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim. A white or yellow pseudomembrane covers the surface of the ulcer. The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx. Most last 7-14 days and occur in crops. Hypopyon may be observed in the anterior chamber. Genitourinary examination of patients with Behcet disease will show ulcers on the scrotum and vulva, painful and heal with scarring. Genital ulcerations tend to be deeper and larger than the oral lesions. Females can have asymptomatic ulcers. Neuromuscular examination of patients with Behcet disease will show CNS involvement in 25% of the cases. Immune-mediated meningoencephalitis predominantly involves the brainstem. Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms can be present. Irreversible dementia can occur. | Patients with Behcet disease usually appear normal. Vital signs of patients with Behcet disease are usually normal. The presence of [[Oral ulcer|mouth sores]], [[Genital ulcer|genital ulcers]], and [[Visual impairment|vision problems]] on physical examination are diagnostic of Behcet disease. [[Skin]] examination of patients with Behcet disease shows [[erythema nodosum]] [[Lesion|lesions]] typically occur on the [[Limb (anatomy)|extremities]], especially the lower legs, but they can also be observed on the [[face]], [[neck]], and [[buttocks]]. The [[Lesion|lesions]] are [[Pain|painful]] and resolve spontaneously, although some may [[Ulcer|ulcerate]] or leave [[hyperpigmentation]]. A [[folliculitis]] like [[rash]], resembling [[Acne vulgaris|acne]] [[Acne Vulgaris|vulgaris]], appears on the [[face]], [[neck]], [[chest]], [[Human back|back]], and [[Stress fracture|hairline]] of patients. Some lesions become more [[Rash|pustular]]; 24-48 hours after a [[Sterility|sterile]] [[needle]] prick, some patients develop [[erythema]] with a [[Nodule (medicine)|nodule]] or [[Abscess|pustule]] at the prick site. Ophthalmoscopic exam may be abnormal with findings of [[retinal]] [[vasculitis]], and vaso-occlusive [[Lesion|lesions]]. [[Uveitis]] of anterior and posterior chambers diagnosed with [[Slit lamp|slit-lamp]] examination. [[Erythema|Erythematous]] throat with [[Tonsillitis|tonsillar]] [[Edema|swelling]], and [[Exudate|exudates]]. [[Ulcer|Ulcers]] 2-15 mm in diameter, with a [[Necrosis|necrotic]] center and surrounding red rim. A white or yellow pseudomembrane covers the surface of the [[ulcer]]. The [[Ulcer|ulcers]] are typically [[Pain|painful]], nonscarring, and found on the lips, [[buccal mucosa]], [[tongue]], [[Tonsil|tonsils]], and [[larynx]]. Most last 7-14 days and occur in crops. [[Hypopyon]] may be observed in the [[anterior chamber]]. [[Genitourinary system|Genitourinary]] examination of patients with Behcet disease will show [[Ulcer|ulcers]] on the [[scrotum]] and [[vulva]], [[Pain|painful]] and heal with [[Scar|scarring]]. [[Sex organ|Genital]] [[Ulcer|ulcerations]] tend to be deeper and larger than the [[oral lesions]]. Females can have asymptomatic [[Ulcer|ulcers]]. [[Neuromuscular junction|Neuromuscular]] examination of patients with Behcet disease will show [[CNS]] involvement in 25% of the cases. [[Immune-mediated disease|Immune-mediated]] [[meningoencephalitis]] predominantly involves the [[Brain stem|brainstem]]. [[Meningitis]], [[encephalitis]], focal [[Neurology|neurological]] deficits, and [[psychiatric]] symptoms can be present. Irreversible [[dementia]] can occur. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with Behcet disease is usually remarkable for: skin lesions, genital lesions, and neuromuscular complications.<ref name="pmid14727454">{{cite journal| author=Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B et al.| title=Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece. | journal=Clin Exp Rheumatol | year= 2003 | volume= 21 | issue= 4 Suppl 30 | pages= S19-26 | pmid=14727454 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727454 }} </ref><ref name="pmid19026127">{{cite journal| author=Moses Alder N, Fisher M, Yazici Y| title=Behçet's syndrome patients have high levels of functional disability, fatigue and pain as measured by a Multi-dimensional Health Assessment Questionnaire (MDHAQ). | journal=Clin Exp Rheumatol | year= 2008 | volume= 26 | issue= 4 Suppl 50 | pages= S110-3 | pmid=19026127 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19026127 }} </ref><ref name="pmid1970380">{{cite journal| author=| title=Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. | journal=Lancet | year= 1990 | volume= 335 | issue= 8697 | pages= 1078-80 | pmid=1970380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1970380 }} </ref> | *Physical examination of patients with Behcet disease is usually remarkable for: [[Skin lesion|skin lesions]], [[Genital ulcer|genital lesions]], and [[Neuromuscular disease|neuromuscular]] complications.<ref name="pmid14727454">{{cite journal| author=Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B et al.| title=Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece. | journal=Clin Exp Rheumatol | year= 2003 | volume= 21 | issue= 4 Suppl 30 | pages= S19-26 | pmid=14727454 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727454 }} </ref><ref name="pmid19026127">{{cite journal| author=Moses Alder N, Fisher M, Yazici Y| title=Behçet's syndrome patients have high levels of functional disability, fatigue and pain as measured by a Multi-dimensional Health Assessment Questionnaire (MDHAQ). | journal=Clin Exp Rheumatol | year= 2008 | volume= 26 | issue= 4 Suppl 50 | pages= S110-3 | pmid=19026127 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19026127 }} </ref><ref name="pmid1970380">{{cite journal| author=| title=Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. | journal=Lancet | year= 1990 | volume= 335 | issue= 8697 | pages= 1078-80 | pmid=1970380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1970380 }} </ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
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===Skin=== | ===Skin=== | ||
* Skin examination of patients with Behcet disease shows the following: | * [[Skin]] examination of patients with Behcet disease shows the following: | ||
**Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks | **[[Erythema nodosum]] lesions typically occur on the [[Limb (anatomy)|extremities]], especially the lower [[Leg|legs]], but they can also be observed on the [[face]], [[neck]], and [[buttocks]] | ||
**The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation | **The [[Lesion|lesions]] are [[Pain|painful]] and resolve spontaneously, although some may [[Ulcer|ulcerate]] or leave [[hyperpigmentation]] | ||
**A | **A [[folliculitis]] like [[rash]], resembling [[acne vulgaris]], appears on the [[face]], [[neck]], [[chest]], [[Human back|back]], and hairline of patients | ||
**Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site | **Some lesions become more [[Rash|pustular]]; 24-48 hours after a [[Sterility|sterile]] needle prick, some patients develop [[erythema]] with a [[Nodule (medicine)|nodule]] or [[Abscess|pustule]] at the prick site | ||
===HEENT=== | ===HEENT=== | ||
*Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, vaso-occlusive lesions | *Ophthalmoscopic exam may be abnormal with findings of [[retinal]] [[vasculitis]], vaso-occlusive lesions | ||
**Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination[13] | **[[Uveitis]] of anterior and posterior chambers diagnosed with [[Slit lamp|slit-lamp]] examination[13] | ||
* Erythematous throat with tonsillar swelling, and exudates | * [[Erythema|Erythematous]] throat with [[Tonsillitis|tonsillar]] [[Edema|swelling]], and [[Exudate|exudates]] | ||
**Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim | **[[Ulcer|Ulcers]] 2-15 mm in diameter, with a [[Necrosis|necrotic]] center and surrounding red rim | ||
**A white or yellow pseudomembrane covers the surface of the ulcer | **A white or yellow pseudomembrane covers the surface of the [[ulcer]] | ||
**The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx | **The [[Ulcer|ulcers]] are typically [[Pain|painful]], nonscarring, and found on the lips, [[buccal mucosa]], [[tongue]], [[Tonsil|tonsils]], and [[larynx]] | ||
**Most last 7-14 days and occur in crops | **Most last 7-14 days and occur in crops | ||
*Hypopyon may be observed in the anterior chamber | *[[Hypopyon]] may be observed in the [[anterior chamber]] | ||
===Neck=== | ===Neck=== | ||
| Line 51: | Line 51: | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with Behcet disease will show: | * Genitourinary examination of patients with Behcet disease will show: | ||
**Ulcers on the scrotum and vulva, painful and heal with scarring | **[[Ulcer|Ulcers]] on the [[scrotum]] and [[vulva]], [[Pain|painful]] and heal with [[Scar|scarring]] | ||
**Genital ulcerations tend to be deeper and larger than the oral lesions | **[[Sex organ|Genital]] [[Ulcer|ulcerations]] tend to be deeper and larger than the oral lesions | ||
**Females can have asymptomatic ulcers | **[[Female|Females]] can have asymptomatic [[Ulcer|ulcers]] | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with Behcet disease will show the following: | * [[Neuromuscular]] examination of patients with Behcet disease will show the following: | ||
**CNS involvement occurs in 25% of the cases | **[[CNS]] involvement occurs in 25% of the cases | ||
**Immune-mediated meningoencephalitis predominantly involves the | **[[Immune-mediated disease|Immune-mediated]] [[meningoencephalitis]] predominantly involves the [[brain stem]] | ||
**Dural venous sinus thrombosis | **[[Cerebral venous sinus thrombosis|Dural venous sinus thrombosis]] | ||
**Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms | **[[Meningitis]], [[encephalitis]], focal [[Neurology|neurological]] deficits, and [[psychiatric]] symptoms | ||
**Irreversible dementia | **Irreversible [[dementia]] | ||
===Extremities=== | ===Extremities=== | ||
*Monoarthritis or polyarthritis | *[[Monoarthritis]] or [[polyarthritis]] | ||
*Knees are the most commonly affected joints, followed by wrists, ankles, and elbows | *[[Knee|Knees]] are the most commonly affected [[Joint|joints]], followed by [[Wrist|wrists]], [[Ankle|ankles]], and [[Elbow|elbows]] | ||
*The arthritis is typically nonerosive | *The [[arthritis]] is typically nonerosive | ||
===Gallery=== | ===Gallery=== | ||
| Line 93: | Line 93: | ||
====Genital area==== | ====Genital area==== | ||
<gallery> | <gallery> | ||
Revision as of 21:56, 2 May 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Patients with Behcet disease usually appear normal. Vital signs of patients with Behcet disease are usually normal. The presence of mouth sores, genital ulcers, and vision problems on physical examination are diagnostic of Behcet disease. Skin examination of patients with Behcet disease shows erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks. The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation. A folliculitis like rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients. Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site. Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, and vaso-occlusive lesions. Uveitis of anterior and posterior chambers diagnosed with slit-lamp examination. Erythematous throat with tonsillar swelling, and exudates. Ulcers 2-15 mm in diameter, with a necrotic center and surrounding red rim. A white or yellow pseudomembrane covers the surface of the ulcer. The ulcers are typically painful, nonscarring, and found on the lips, buccal mucosa, tongue, tonsils, and larynx. Most last 7-14 days and occur in crops. Hypopyon may be observed in the anterior chamber. Genitourinary examination of patients with Behcet disease will show ulcers on the scrotum and vulva, painful and heal with scarring. Genital ulcerations tend to be deeper and larger than the oral lesions. Females can have asymptomatic ulcers. Neuromuscular examination of patients with Behcet disease will show CNS involvement in 25% of the cases. Immune-mediated meningoencephalitis predominantly involves the brainstem. Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms can be present. Irreversible dementia can occur.
Physical Examination
- Physical examination of patients with Behcet disease is usually remarkable for: skin lesions, genital lesions, and neuromuscular complications.[1][2][3]
Appearance of the Patient
- Patients with Behcet disease usually appear normal.
Vital Signs
- Vital signs of patients with Behcet disease are usually normal.
Skin
- Skin examination of patients with Behcet disease shows the following:
- Erythema nodosum lesions typically occur on the extremities, especially the lower legs, but they can also be observed on the face, neck, and buttocks
- The lesions are painful and resolve spontaneously, although some may ulcerate or leave hyperpigmentation
- A folliculitis like rash, resembling acne vulgaris, appears on the face, neck, chest, back, and hairline of patients
- Some lesions become more pustular; 24-48 hours after a sterile needle prick, some patients develop erythema with a nodule or pustule at the prick site
HEENT
- Ophthalmoscopic exam may be abnormal with findings of retinal vasculitis, vaso-occlusive lesions
- Erythematous throat with tonsillar swelling, and exudates
- Hypopyon may be observed in the anterior chamber
Neck
- Neck examination of patients with Behcet disease is usually normal.
Lungs
- Pulmonary examination of patients with Behcet disease is usually normal.
Heart
- Cardiovascular examination of patients with Behcet disease is usually normal.
Abdomen
Abdominal examination of patients with Behcet disease is usually normal.
Back
- Back examination of patients with Behcet disease is usually normal.
Genitourinary
- Genitourinary examination of patients with Behcet disease will show:
Neuromuscular
- Neuromuscular examination of patients with Behcet disease will show the following:
- CNS involvement occurs in 25% of the cases
- Immune-mediated meningoencephalitis predominantly involves the brain stem
- Dural venous sinus thrombosis
- Meningitis, encephalitis, focal neurological deficits, and psychiatric symptoms
- Irreversible dementia
Extremities
- Monoarthritis or polyarthritis
- Knees are the most commonly affected joints, followed by wrists, ankles, and elbows
- The arthritis is typically nonerosive
Gallery
Oral cavity
Genital area
References
- ↑ Zouboulis CC, Vaiopoulos G, Marcomichelakis N, Palimeris G, Markidou I, Thouas B; et al. (2003). "Onset signs, clinical course, prognosis, treatment and outcome of adult patients with Adamantiades-Behçet's disease in Greece". Clin Exp Rheumatol. 21 (4 Suppl 30): S19–26. PMID 14727454.
- ↑ Moses Alder N, Fisher M, Yazici Y (2008). "Behçet's syndrome patients have high levels of functional disability, fatigue and pain as measured by a Multi-dimensional Health Assessment Questionnaire (MDHAQ)". Clin Exp Rheumatol. 26 (4 Suppl 50): S110–3. PMID 19026127.
- ↑ "Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease". Lancet. 335 (8697): 1078–80. 1990. PMID 1970380.