Concurrent presentation of Behçet's disease and seronegative spondylitis in a Syrian female patient: a case report

Seronegative spondylitis encompasses diseases characterized by axial and peripheral arthritis, dactylitis, enthesitis, and extra-articular manifestations. Behçet's disease (BD), a chronic inflammatory vasculitis associated with HLA, notably HLA-B51, has shown an increasing co-occurrence with ankylosing spondylitis (AS). Proinflammatory cytokines and genetic factors are implicated in their pathogenesis. The classification of BD within seronegative spondylitis and the development of sacroiliitis in BD remain debated. This case report highlights the unique coexistence of Behçet's disease (BD) and seronegative spondylitis, contributing to the limited body of literature on this rare dual diagnosis. A 43-year-old Syrian female presented with chronic inflammatory back pain, joint symptoms, and a 20-year history of bloody diarrhea, and uveitis, along with oral and genital ulceration. A diagnostic evaluation revealed fulfilling criteria for both BD and seronegative spondylitis. Physical examination demonstrated tenderness in sacroiliac joints, dactylitis, synovitis, Raynaud's disease, and a rash consistent with lichen planus. Imaging studies, including pelvic X-ray and MRI, showcased characteristic findings of axial involvement. The patient received a multidisciplinary treatment regimen, resulting in improved gastrointestinal symptoms and extra-articular manifestations, yet persistent back pain. The overlap of BD and axial spondylitis poses diagnostic and therapeutic challenges, necessitating a tailored approach. Recognizing shared immunopathogenetic mechanisms underscores the importance of targeted therapies in managing both conditions. Further research is needed to clarify the underlying mechanisms and optimize treatment strategies for this complex dual diagnosis.