^{1, 2}Suad Hannawi, ³Maria Al-Salmi, ¹Haifa Hannawi

¹Al Kuwait-Dubai (Al Baraha) Hospital, Emirates Health Services (EHS), ²Ministry of Health and Prevention (MOHAP), ³Medical and Health Sciences, Sharjah University

Introduction: Behcet’s disease (BD) is an inflammatory systemic vasculitis condition of unknown etiology, involving multiple organ systems such as mucous membranes, skin, joints, intestines, lungs, central nervous system, and vessels. Psoriasis is a chronic proliferative and inflammatory condition of the skin,  characterized by erythematous plaques covered with silvery scales.

Despite that the pathogenesis of BD and psoriasis share common perspectives, yet, reports of patients who have both diseases are rare. Therefore, BD may place individuals at increased risk of PsO. The risk had been suggested to be more in the male cohort, and senile population.

On the other hand, the inclusion of Behcet’s disease among seronegative spondyloarthropathies is still being debated.

Method(s): We are presenting a case of BD who has a typical psoriatic skin patch.

Result(s): A 48-year-old man of Arabic ethnicity was referred from the ophthalmology clinic (where he is under care for recurrent bilateral iritis) to the rheumatology department of Al Kuwait-Dubai (Al Baraha) Hospital.

Detailed history revealed a history of chronic sinusitis, Recurrent rash over the shins and the extensor surface of the forearms, recurrent painful mouth ulceration, recurrent genital ulceration, Headache on and off for the last few years, chronic constipation, generalized bone pain, and low back pain. The lower back was typical of inflammatory back pain in characteristics.

Family history was significant for diabetes in the father and mother, hypertension and cardiovascular disease in the father, asthma in the mother, and systemic lupus erythematous in a paternal cousin.

Examination revealed a small macular rash over the anterior surface of the right shin, and the extensor surface of the left elbow surface of the right shin (Figures 1, and 2).

Also, interestingly there were dry, itchy, raised skin patches (plaques) covered with white silvery scales over the extensor surface of the right knee (Figure 3.).

Laboratory investigations revealed normal complete blood counts, erythrocyte sedimentation rate (ESR), C-reactive protein, liver, and renal function. Antibodies profile and HLA-B27 were all negative.

X-rays of the cervical, thoracolumbar, and sacroiliac joints  (SIJs) came normal. Magnetic resonance imaging for SIJS was completely normal with no evidence of edema or erosions.

The diagnosis was BD based on the International Criteria for Behcet’s Disease (ICBD), and skin PsO based on the presence of a psoriatic lesion in the clinical examination. Whether the BD and the skin PsO are part of a broader spondylarthritis (especially in view of the history of inflammatory back pain) is not clear as the symptoms do not fit within the Spondylarthritis International Society (ASAS) criteria

Conclusion(s): Behcet’s disease may be associated with a significantly increased risk of psoriasis, and probably psoriatic arthritis.