Mucocutaneous ulceration in a previously healthy man
In a matter of days, the patient had developed ulcers in his mouth and on his forearms, back, scalp, and genital area. His history of oral aphthous ulcers provided an important diagnostic clue.
Treatment focuses on alleviating symptoms
There is no curative treatment for BD. The goals of treatment are to prevent end organ damage and alleviate the symptoms.
Mucocutaneous disease is treated with potent topical corticosteroids. Severe attacks are treated with oral corticosteroids—1 mg/kg of prednisolone.7 The drug is tapered and discontinued once the disease is under control. Colchicine or dapsone also is an option. In refractory cases, consider thalidomide (50 mg once a day) or azathioprine (1-3 mg/kg).2,7 An anti-tumor necrosis factor agent also may be considered.
A good outcome for our patient
Our patient was evaluated by an ophthalmology colleague who found no evidence of ocular involvement.
We initially prescribed prednisolone 60 mg once a day for this patient, but when he was weaned off of it, he relapsed. We then prescribed thalidomide 50 mg once a day for 4 months, and the disease resolved completely. The thalidomide was then reduced to 50 mg 3 times a week for 4 weeks, and then stopped completely.
Nearly 2 years later, our patient remains disease free.
CORRESPONDENCE
Arif Aslam, MBChB, MRCP (UK), Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD United Kingdom; a.aslam@doctors.org.uk
