Bakti Fitrah Utari, Sufiawati Irna
Oral Medicine Residency, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
Int Med Case Rep J. 2025 Jan 10;18:41-52. doi: 10.2147/IMCRJ.S487703. eCollection 2025.
The Behçet's Disease Current Activity Form (BDCAF) is crucial for monitoring the progression and treatment efficacy of Behçet's Disease (BD), an autoimmune disorder that can be triggered or exacerbated by viral infections. Herpes simplex virus type 1 (HSV-1) has long been recognized as a potential trigger for BD, as it can induce systemic inflammation and exacerbate symptoms. In contrast, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has recently emerged and may also initiate or worsen BD symptoms. This report examines three BD cases with oral manifestations specifically triggered by HSV-1 and SARS-CoV-2, comparing their clinical activity and treatment responses.
Three female patients, aged 29, 24, and 41 years, presented to the Oral Medicine Department with complaints of canker sores, along with genital and skin lesions and red eyes. Intraoral examination showed ulcerative, erosive, and white plaque lesions throughout the oral mucosa. The first patient was confirmed to have COVID-19 by the SARS-CoV-2 RNA test. The second and third patients had a two-year history of recurrent oral ulcerations with reactive IgG anti-HSV-1 tests. All patients were diagnosed with BD according to the International Criteria for Behcet's Disease. The BDCAF measurements were conducted, showing a BD activity index score of 4 for the COVID-19-positive patient, while scores of 6 and 7 were recorded for the other two patients with seropositive HSV-1.
Medications provided include corticosteroid, antimetabolite, analgesic, antiviral, antifungal, antiseptic mouthwash, and multivitamin. All patients showed good clinical improvement after treatment.
The BD activity index scores of a BD patient with COVID-19 were lower than those with HSV-1 infection. This difference may be due to the recent SARS-CoV-2 infection in the patient, whereas reactivation of chronic latent HSV-1 in the other patients likely contributed to a longer history of clinical manifestations, resulting in increased disease activity.
白塞病当前活动形式（BDCAF）对于监测白塞病（BD）的进展和治疗效果至关重要，白塞病是一种自身免疫性疾病，可由病毒感染引发或加重。1型单纯疱疹病毒（HSV-1）长期以来被认为是BD的潜在触发因素，因为它可诱发全身炎症并加重症状。相比之下，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）最近出现，也可能引发或加重BD症状。本报告研究了3例由HSV-1和SARS-CoV-2特别引发口腔表现的BD病例，比较了它们的临床活动和治疗反应。
3名女性患者，年龄分别为29岁、24岁和41岁，因口腔溃疡、生殖器及皮肤病变和眼红就诊于口腔内科。口腔检查显示整个口腔黏膜有溃疡性、糜烂性和白色斑块病变。首例患者经SARS-CoV-2 RNA检测确诊为新冠肺炎。第二例和第三例患者有复发性口腔溃疡两年病史，HSV-1反应性IgG检测呈阳性。所有患者均根据白塞病国际标准诊断为BD。进行了BDCAF测量，新冠肺炎阳性患者的BD活动指数评分为4分，而另外两名HSV-1血清学阳性患者的评分分别为6分和7分。
提供的药物包括皮质类固醇、抗代谢药、镇痛药、抗病毒药、抗真菌药、抗菌漱口水和多种维生素。所有患者治疗后临床均有良好改善。
新冠肺炎BD患者的BD活动指数评分低于HSV-1感染患者。这种差异可能是由于患者近期感染了SARS-CoV-2，而其他患者慢性潜伏HSV-1的重新激活可能导致临床表现病史更长，从而导致疾病活动增加。
