Arkania Nabila, Rahma Wijayanti Rizky, Kus Megawati Fatima, Fauziyah Rizka, Febriana Sri Awalia
Department of Dermatovenereology, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Special Region of Yogyakarta, IDN.
Cureus. 2025 Aug 26;17(8):e91050. doi: 10.7759/cureus.91050. eCollection 2025 Aug.
The symptoms of Behçet's disease (BD), a chronic, multisystem inflammatory disease, include skin lesions, uveitis, oral and vaginal mucosal ulcers, and involvement of other organ systems. Genital ulcers are one of the main manifestations of BD and can mimic sexually transmitted infections (STIs). It can be difficult to diagnose BD, particularly in patients who have immunological comorbidities such as non-Hodgkin lymphoma (NHL). This case report highlights the importance of a comprehensive diagnostic approach for atypical vaginal ulcers in NHL patients. A 31-year-old woman with a history of NHL undergoing R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy regimen was referred with complaints of painful and purulent ulcers in the perianal and vaginal areas. Physical examination showed multiple well-circumscribed ulcers with purulent exudate. Laboratory examinations ruled out STIs, and pathergy test results were positive. Based on the history, clinical findings, and supporting examination results, the patient was diagnosed with genital ulcers due to BD with secondary infection. The diagnosis of genital ulcers in BD is based on clinical criteria and positive pathergy test results, after excluding differential diagnoses such as genital herpes, warts, and syphilis. A history of NHL and chemotherapy likely influenced this patient's clinical presentation and immune response. Although positive herpes simplex virus (HSV)-2 IgG serology suggested past infection, there was no evidence of acute infection, but HSV reactivation may have been a trigger or aggravating factor in BD lesions. Management included systemic and topical antibiotics to treat secondary infection and local treatments to reduce inflammation and promote healing. This case illustrates an atypical presentation of genital ulcers due to BD in a patient with NHL undergoing chemotherapy. To make the right diagnosis and treat this patient, a thorough diagnostic process involving the patient's history, physical examination, laboratory work, and pathology testing was necessary.
白塞病（BD）是一种慢性多系统炎症性疾病，其症状包括皮肤病变、葡萄膜炎、口腔和阴道黏膜溃疡以及其他器官系统受累。生殖器溃疡是BD的主要表现之一，可类似性传播感染（STIs）。BD的诊断可能困难，尤其是在患有免疫性合并症如非霍奇金淋巴瘤（NHL）的患者中。本病例报告强调了对NHL患者非典型阴道溃疡采取综合诊断方法的重要性。一名有NHL病史且正在接受R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）化疗方案的31岁女性，因肛周和阴道区域疼痛性脓性溃疡前来就诊。体格检查发现多个边界清晰的溃疡并有脓性渗出物。实验室检查排除了性传播感染，针刺反应试验结果为阳性。根据病史、临床发现及辅助检查结果，该患者被诊断为BD所致生殖器溃疡伴继发感染。BD中生殖器溃疡的诊断基于临床标准和针刺反应试验结果阳性，需排除诸如生殖器疱疹、疣和梅毒等鉴别诊断。NHL病史和化疗可能影响了该患者的临床表现和免疫反应。虽然单纯疱疹病毒2型（HSV）IgG血清学阳性提示既往感染，但无急性感染证据，但HSV再激活可能是BD病变的触发因素或加重因素。治疗包括全身和局部使用抗生素治疗继发感染以及局部治疗以减轻炎症和促进愈合。本病例说明了一名接受化疗的NHL患者中BD所致生殖器溃疡的非典型表现。为做出正确诊断并治疗该患者，有必要进行全面的诊断过程，包括患者病史、体格检查、实验室检查和病理检测。
