Tuberculosis Masquerading as Behcet's Disease‐Pseudo Bechet's Syndrome: A Case‐Based Review of Literature

TL;DR

This paper reports a case of tuberculosis mistaken for Behcet's disease, highlighting the importance of accurate diagnosis to avoid inappropriate treatment.

Contribution

The paper adds a new case to the literature showing tuberculosis can mimic Behcet's disease, emphasizing diagnostic considerations in endemic regions.

Findings

A 33-year-old man with Behcet's-like symptoms was diagnosed with tuberculosis via pleural biopsy.

Anti-tubercular therapy resolved all symptoms within four months.

Nine cases were identified where tuberculosis presented as Behcet's disease.

Abstract

Behcet's disease is a chronic, multisystem variable vessel vasculitis characterised by recurrent oral and genital ulcers, ocular inflammation and a wide range of systemic manifestations. Pseudo‐Behcet's syndrome refers to a condition that mimics these clinical features but arises from distinct etiologies. We present a case of a 33‐year‐old male with year‐long recurrent oral ulcers and intermittent abdominal pain, followed by scrotal ulcers, severe fatigue, weight loss and appetite loss. Chest imaging demonstrated bilateral consolidations with cavitation and right‐sided pleural effusion, prompting consideration of a Behcet's mimic. Thoracoscopic pleural biopsy revealed acid‐fast bacilli, confirming tuberculosis. A diagnosis of Pseudo‐Behcet's secondary to tuberculosis was made. Initiation of anti‐tubercular therapy led to complete resolution of symptoms within 4 months. A literature review identified nine cases (including the index case) in which tuberculosis presented with Behcet's‐like features, underscoring the complex association between Behcet's disease and tuberculosis. This case underscores the need to consider tuberculosis as a Behcet's disease mimic, particularly in endemic areas, to prevent misdiagnosis and inappropriate immunosuppression.

We report a case of recurrent oral/scrotal ulcers with systemic symptoms in a 33‐year‐old man masked pulmonary tuberculosis: imaging showed cavitary consolidations with effusion, and thoracoscopic pleural biopsy demonstrated acid‐fast bacilli. Anti‐tubercular therapy led to complete resolution, underscoring TB as a key Behçet's mimic to exclude before immunosuppression in endemic regions.

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