Behçet’s Disease in a Patient With Non-Hodgkin Lymphoma: A Case of Genital Ulceration Resembling a Sexually Transmitted Disease

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.