# Recurrent Oral Ulcers: Are They Horses or Zebras?

## TL;DR

This paper discusses a case where persistent oral ulcers led to the diagnosis of Behçet's disease, highlighting the importance of considering systemic conditions.

## Contribution

The paper emphasizes the need for early recognition of Behçet's disease in patients with recurrent oral ulcers.

## Key findings

- Recurrent oral ulcers unresponsive to treatment may indicate Behçet's disease.
- HLA B51 positivity and rheumatology referral led to a correct diagnosis and effective treatment.

## Abstract

Oral ulcers are one of the most common complaints seen by general practitioners in their offices. Recurrent aphthous stomatitis affects roughly 20% of the general population. When ulcers persist despite conventional treatment, it is crucial to consider systemic diseases such as Behçet's disease to prevent delays in care. Early recognition and appropriate management of underlying conditions are essential for improving patient outcomes and quality of life. We present a case of a 41-year-old Scottish male who came in with complaints of recurrent oral ulcers and oral thrush. Initial treatment by an infectious disease specialist resolved the oral thrush but not the ulcers. Despite further treatment attempts for three years, including biopsy and antiviral therapy, ulcers persisted. Finally, referral to rheumatology led to comprehensive autoimmune testing, revealing positive HLA B51 and a diagnosis of Behçet's disease. Treatment with topical steroids and colchicine yielded significant improvement.