Confusing untypical intestinal Behcet’s disease: Skip ulcers with severe lower gastrointestinal hemorrhage

Table 1 Results of clinical laboratory tests and examinations

Clinical examinations	Results
Routine blood examination	White blood cells 14400/μL, red blood cells 408 × 104/μL, hemoglobin 11.6 g/dL, hematocrit 35.7%, platelets 220 × 104/μL, C-reactive protein 38.9 mg/dL, blood sedimentation 58 mm/h
Routine stool examination	White blood cells, 20-30/HP; red blood cells, filled visual fields
Blood biochemistry	Total protein, 8.6 g/dL; AST, 36 IU/L; ALT, 32 IU/L; LDH, 171 IU/L; and total bilirubin, 0.2 mg/dL
Bacteriologic culture of blood, urine, and stool	Negative
Serum antinuclear antibody and antituberculosis antibody	Negative
PPD skin test and T-spot test	Negative
Pathergy test	Positive
Gastroscopy	Giant ulceration in the inferior extremity of the esophagus (Figure 1A)
Colonoscopy	A large ulcer in the ileo-cecal junction (Figure 1B)
Pathological examination of the endoscopic biopsy specimen	Nonspecific ulceration
Abdominal CT imaging	Thickening of the intestinal canal of the ascending colon and ileocecal region
Whole gastrointestinal barium meal examination	Inflammatory changes in the ascending colon and ileocecal region

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDH: Lactate dehydrogenase; CT: Computed tomography.

Table 2 Diagnostic Criteria (Behcet’s Disease Resarch Committee of Japan, 1987)

Maior

Recurrent aphthous ulceration of the oral mucous membrane

Skin lesion

Erythema nodosum

Subcutaneous thrombophlebitis

Folliculitis, acne-like lesion

Cutaneous hyperirritability

Eye lesion

Iridocyclitis

Chorioretinitis, retinouveitis

Definite history of chorioretinitis of retinouveitis

Genital ulcer

Minor

Arthritis without deformity and ankylosis

Gastrointestinal lesion characterized by ileocecal ulcers

Epididymitis

Vascular lesion

Central nervous system symptoms

Diagnosis

Complete type:4 major features

Incomplete type:

3 major features

Major + 2 minor features

Typical ocular symptom + 1 major or 2 minor features

Suspected type:

2 major features

1 major + 2 minor

Table 3 Guideline Statements for Diagnosis of Intestinal Behcet’s Disease (Japan)

Diagnosis of intestinal Behcet’s disease can be made if

There is a typical oval-shaped large ulcer in the terminal ileum or

There are ulcerations or inflammation in the small or large intestine;

And clinical findings meet the diagnostic criteria of Behcet’s disease