A 23-year-old female consulted a gynaecological service for vulvar pain and oedema. There were lesions on her vulvar skin and she reported having intermittent fever. Moreover, her family history was insignificant.
A detailed clinical examination confirmed vulvar oedema. Furthermore, it showed erosive papules on the vulvar skin. Based on these findings, doctors diagnosed her with herpes simplex-2 infection (HSV-2). They prescribed her valaciclovir along with some anti-inflammatory medicines and discharged her right away.
Ophthalmological Disturbances
One day after being discharged, the patient presented to the emergency with complaints of visual disturbances in addition to persistent lesions in the genital region. On examination, she had bilaterally decreased visual acuity. On suspicion of retinal haemorrhages, doctors advised her to see an ophthalmologist. Furthermore, because visual disturbances can be a side effect of valaciclovir, doctors replaced her antiviral with acyclovir.
Another Gynaecological Consultation!
Four days post her initial presentation, the patient consulted gynaecological emergency services again. This time for painful genital ulcers and urinary retention. However, she still suffered from visual blurriness. Furthermore, due to severe pain from genital ulcers, she did not visit an ophthalmologist.
The doctors made a list of differentials including HSV, syphilis and Behçet’s disease. They inserted a urinary catheter and referred her to the ophthalmology department. The ophthalmologists examined her visual symptoms. They noticed micro-haemorrhages and other micro-angiopathies in her retina. Based on her visual decline and genital ulcers, her symptoms were significant of Behçet’s disease.
The doctors started her on IV steroids treatment. Moreover, they also included infliximab and azathioprine (for long-term maintenance) in her treatment plan. It improved her vision and her vulvar ulcers also healed within a few days.
An Insight Into Behçet’s Disease
It’s a rare disease that involves vascular injuries and oral and genital ulcers. In addition, it causes visual disturbances and also affects the GI tract.
