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\begin{document}

\title{An unusual localization of genital ulcer in Beh\selectlanguage{ngerman}çet's disease: external
urethral meatus\selectlanguage{english}}



\author[1]{Cagri Turan}%
\author[1]{İbrahim  Karabulut}%
\affil[1]{Erzurum Training and Research Hospital}%


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  \date{May 25, 2024}


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\selectlanguage{ngerman}\textbf{An unusual localization of genital ulcer in Behçet's disease:
external urethral meatus}

\textbf{Running head:} Unusual genital ulcer in Behçet's disease

Ça\selectlanguage{polish}ğ\selectlanguage{english}r\selectlanguage{polish}ı \selectlanguage{english}Turan\textsuperscript{1}, \selectlanguage{polish}İ\selectlanguage{english}brahim Karabulut \textsuperscript{2}

\textsuperscript{1}Department of Dermatology and Venereology, the
Republic of Turkey, Health Sciences University Erzurum Regional Training
and Research Hospital, Turkey

\textsuperscript{2}Department of Urology, the Republic of Turkey, Health
Sciences University Erzurum Regional Training and Research Hospital,
Turkey

\textbf{Corresponding Author} : \selectlanguage{ngerman}Ça\selectlanguage{polish}ğ\selectlanguage{english}r\selectlanguage{polish}ı \selectlanguage{english}TURAN; Department of Dermatology
and Venereology, the Republic of Turkey, Health Sciences University
Erzurum Regional Training and Research Hospital, Turkey; \selectlanguage{ngerman}Üniversite
Mahallesi, Çat Yolu Cd., Yakutiye/Erzurum, Post Code: 25070

e-mail: cagrituranmd@gmail.com, telephone number: +905445252504

\textbf{Word count:} 471

\textbf{Table count:} 0

\textbf{Supplementary table:} 0

\textbf{Figure count:} 1

\textbf{Funding sources} : We declare no financial support or
relationships that may pose a conflict of interest.

\textbf{Conflict of interest:} There is no conflict of interest.

The paper has not been published or submitted for publication elsewhere.

All authors have contributed significantly, and all authors agree with
the content of the manuscript.

Informed consent form was obtained from the patient.

\textbf{Key words:} Behçet's disease, genital ulcer, Urethra, Vasculitis

Dear editor,

Behçet's disease (BD) is a chronic, recurrent, multisystemic vasculitis
which can affect all vascular system. The most common symptom is genital
ulcer accompanying oral aphthae, and its diagnosis is currently made
according to the International Criteria for Behçet's Disease (ICBD).
Providing two points for oral aphthae, genital ulcers, and ocular
involvement and one point for the other skin lesions (erythema nodosum,
papulopustular/acneiform lesions in post-adolescent), vascular
involvement, and neurological findings are evaluated if the patient
scores reach four or more; the patient is considered to be
BD\textsuperscript{1, 2}. In men, genital aphthous ulcers occur in 60 to
65\% of cases and are most common in the scrotum, shaft and glans penis,
and rarely in the groin and perineum, extremely rare in the urethral
orifice\textsuperscript{2, 3}

We presented a patient with a complaint of painful micturition,
ultimately diagnosed with BD. A 34-year-old male patient was consulted
from the urology following the evaluation of his painful voiding
complaint 10 days accompanying wound in the periurethral orifice. On
genital examination, an oval, and sharp circumscribed aphthous ulcer
with a serous floor, approximately 4 mm in diameter, was seen on the
external urethral~orifice (Figure 1a). The patient who had no known
disease has refused to use any medication, similar complaints,
suspicious sexual contact, except for oral aphthae recurring 8-10 times
a year (Figure 1b). After noticing a few pustular lesions with
peripheral partial erythema on his back, we focused on BD and
inflammatory bowel diseases in the examination (Figure 1c). We learned
that the patient had no family history and other related symptoms. Bowel
habits were normal. Hepatitis, HIV, syphilis serologies were negative.
CRP and sedimentation were 3.2 mg/dl (0-5 mg/dl) and 27 mm/hour (0-20
mm/hour); respectively. Other hematological and biochemical parameters
were within normal limits. Complement levels, antinuclear antibody,
anti-dsDNA, p-ANCA, c-ANCA and rheumatoid factor were normal. Pathergy
test was positive. The patient was diagnosed with BD with a score of 6
according to the current ICBD, and no pathology was found in the eye and
cardiology consultations. His complaints improved within 1 week without
leaving any scar, after treatment with topical betamethasone valerate
applied to the urethral orifice and oral colchicine 1.5 mg/day. No
clinical progression has been observed for 2 years in the follow-up.

A urethral ulcer is an unusual finding in BD. Akta\selectlanguage{polish}ş \selectlanguage{english}recently reported a
27-year-old male patient with clinical features quite similar to our
case, but with negative pathergy\textsuperscript{4}. Interestingly,
Cobilinschi et al. reported that a 34-year-old female patient with BD
who was admitted with progressive dysuria, pain in the right lumbar
region, and hydronephrosis was determined a necrotic ulcer in the ureter
whose histopathology was compatible with vasculitis\textsuperscript{5}.

We present this case to draw attention to the aphthous ulcer in the
urethra as an unusual genital involvement for BD, and the importance of
physical examination.

\textbf{References:}

1. Davatchi F, Assaad-Khalil S, Calamia K, et al: The International
Criteria for Beh\selectlanguage{ngerman}çet's Disease (ICBD): A collaborative study of 27
countries on the sensitivity and specificity of the new criteria.\emph{J
Eur Acad Dermatol Venereol} 2014;28(3):338-47.

2. Alpsoy E, Zouboulis CC and Ehrlich GE: Mucocutaneous lesions of
Behcet's disease. \emph{Yonsei Med J} 2007;48(4):573-85.

3. Altenburg A, Papoutsis N, Orawa H, Martus P, Krause L and Zouboulis
CC: {[}Epidemiology and clinical manifestations of Adamantiades-Behçet
disease in Germany -- current pathogenetic concepts and therapeutic
possibilities{]}. \emph{J Dtsch Dermatol Ges} 2006;4(1):49-64.

4. Akta\selectlanguage{polish}ş \selectlanguage{english}H: An extraordinary manifestation of Beh\selectlanguage{ngerman}çet's disease in a
young male: Urinary meatus ulcer. \emph{Int J Rheum
Dis}2020;23(2):271-72.

5. Cobilinschi C, Belinski C and Opris-Belinski D: Rare case of female
Behçet's disease with urological involvement. \emph{Rom J
Rheumatol}2019;28(2):80-83.

\textbf{Figure Legend:}

\textbf{Figure 1.} a: an aphthous ulcer with a serous base, oval and
sharply circumscribed, about 4 mm in diameter, in the left lateral
aspect of the external urethral orifice; b: oral aphthae; c: a pustule
with peripheral, partial erythema on the back\selectlanguage{english}
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