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Is Behçet’s syndrome associated with infection?
  1. A P Rozin1
  1. 1B Shine Department of Rheumatology, Rambam Medical Centre and B Rappaport Faculty of Medicine, Israel-Technion Institute of Technology, Haifa, Israel
  1. Correspondence to:
    Dr A Rozin
    Department of Rheumatology, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel;

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I read with interest that the pustular skin lesions in Behçet’s syndrome (BS) had been thought aseptic, were found to be not sterile, and that the microbiology of these lesions is different from ordinary acne.1 I would like to report my observation of a patient with refractory pustulosis of Behçet’s disease, who fulfilled the international study group criteria, was HLA-Bw51 positive, and had a family history of BS. The patient’s skin rash disappeared after a 6 week course of co-trimoxazole (sulfamethoxazole-trimetoprim).

The patient, a 31 year old man had had recurrent oral and genital ulcers since childhood. Inflammatory joint disease developed 4 years ago, affecting shoulders, ankles, and knees, relapsing every 2–3 months. Recurrent knee effusions caused serious knee dysfunction. Skin pustulosis, which was episodic at onset, became persistent and massive during the past 4 years, affecting the body, back, and limbs (fig 1A). A skin vesicle was observed 24–48 hours after taking blood for analysis from the knee at the point of needle entry. Polyarthritis and skin pustulosis became refractory to local, systemic, and intra-articular corticosteroids and colchicine. The pustular lesions thought to be sterile in BS were not cultured. Salazopyrin, methotrexate given orally and parenterally at maximal dose of 25 mg/week, and azathioprine failed to control the …

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