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Probable triple symptom complex of Behcet: Scrotal tongue
544
QUARTERLY
REVIEW
OF LITERATURE
“Dr. Bernard Appel, Lynn, Mass.: ‘The lesions on the lips and in the mouth are, in my opinion, consistent with lupus erythematosus. It is not unusual, in my experience, to find lesions on the lips which in the early stages resemble those of lichen planus clinically because of the white reticulation and their limitation to the vermilion border of the lip. With the progress of the disease, however, the lesions become more characteristic as they extend to the glabrous skin. I anticipate that that is what will happen in this case. Furthermore, I have not found that lichen planu’s produces such extensive and persistent ulceration of the tongue when it does occur there; that is to sa.v, this picture is more conIf it actually is lupus erythematosus, it is al,so my sistent with lupus erythematosus. opinion that it is likely to be extremely resistant to treatment and that the prognosis should be guarded. “Dr. Francis P. McCarthy, show epithelioid tissue? “Dr.
Fred Weidman,
‘(Dr.
Francis
“Dr.
Fred
Philadelphia:
P. McCarthy:
Weidman:
Boston:
Dr. Weidman,
does the lesion
on the tongue
Yes.
Da we get this reaction
in lupus erythematosus?
No.
The question of tuberculosis of the tongue also came “Dr. Maurice J. Costello: up, but roentgenograms showed the chest to be normal. We have seen patients who had both lichen planus and lupus erythematosus simultaneously. I think the lesione on the lower lip suggest lichen planus and am inclined to agree that the lesion on the tongue is lupus erythematosus or lichen planus clinically. ’ ’
Scrotal Tongue. Probable Triple Symptom Complex of Behcet: Arch. Dermat. & Syph. 60: 864, 1949. Senear and Staff.*
Presented by F. E.
“A. I., a white housewife aged 29, was shown at the December meeting of this She gave a five months’ history of recurrent ulsociety with a condition for diagnosis. cerative lesions of the mouth which had not responded to various local treatments or to At the intravenous treatment for a diagnosis of ‘trench mouth’ made prior to admission. time of presentation, .she showed a marginal scrotal tongue with whitish patches of membrane extending from some of the crypts of the tongue, as well as scattered on the buccal These were relatively easily removed, leaving superficial tender ulmucous membranes. cerations without bleeding and surrounded by an erythematous halo. Direct examinations During the discussion the following diagnoses were mentioned did not reveal mycelia. as possibilities: (1) aphthous stomatitis, (2) moniliasis, (3) eruption due to drugs, (4) Behcet’s triple symptom complex and (5) scrotal tongue. “Medical consultation revealed nothing contributory. The urine was normal; blood cell counts were normal; the results of the serologic test for syphilis and examination Examination by the gynecologic consultant showed only of the chest were all negative. Repeated cultures from the mouth lesions failed to demonstrate chronic cervicitis. Monilia, although cultures from vaginal discharge on one occasion did grow mucoid coloOn one occasion, the patient comnies with budding forms on microscopic examination. plained of soreness about the vulva, and examination in our department revealed superficial ulcerations about the labia minora and majora. “On about the first of February, the patient was found to have decided infection of the right conjunctiva diagnosed as episcleritis by the ophthalmologic consultant. This was considered consistent with, though not diagnostic of, Behcet’s syndrome of the eye. She stated that she had had one previous similar, though less severe, attack of ocular inflammation about five weeks ago.” *Chicago
Dermatological
Society.
QUARTERLY
REVIEW
OF LITERATURE
“Dr. Bernard Appel, Lynn, Mass.: ‘The lesions on the lips and in the mouth are, in my opinion, consistent with lupus erythematosus. It is not unusual, in my experience, to find lesions on the lips which in the early stages resemble those of lichen planus clinically because of the white reticulation and their limitation to the vermilion border of the lip. With the progress of the disease, however, the lesions become more characteristic as they extend to the glabrous skin. I anticipate that that is what will happen in this case. Furthermore, I have not found that lichen planu’s produces such extensive and persistent ulceration of the tongue when it does occur there; that is to sa.v, this picture is more conIf it actually is lupus erythematosus, it is al,so my sistent with lupus erythematosus. opinion that it is likely to be extremely resistant to treatment and that the prognosis should be guarded. “Dr. Francis P. McCarthy, show epithelioid tissue? “Dr.
Fred Weidman,
‘(Dr.
Francis
“Dr.
Fred
Philadelphia:
P. McCarthy:
Weidman:
Boston:
Dr. Weidman,
does the lesion
on the tongue
Yes.
Da we get this reaction
in lupus erythematosus?
No.
The question of tuberculosis of the tongue also came “Dr. Maurice J. Costello: up, but roentgenograms showed the chest to be normal. We have seen patients who had both lichen planus and lupus erythematosus simultaneously. I think the lesione on the lower lip suggest lichen planus and am inclined to agree that the lesion on the tongue is lupus erythematosus or lichen planus clinically. ’ ’
Scrotal Tongue. Probable Triple Symptom Complex of Behcet: Arch. Dermat. & Syph. 60: 864, 1949. Senear and Staff.*
Presented by F. E.
“A. I., a white housewife aged 29, was shown at the December meeting of this She gave a five months’ history of recurrent ulsociety with a condition for diagnosis. cerative lesions of the mouth which had not responded to various local treatments or to At the intravenous treatment for a diagnosis of ‘trench mouth’ made prior to admission. time of presentation, .she showed a marginal scrotal tongue with whitish patches of membrane extending from some of the crypts of the tongue, as well as scattered on the buccal These were relatively easily removed, leaving superficial tender ulmucous membranes. cerations without bleeding and surrounded by an erythematous halo. Direct examinations During the discussion the following diagnoses were mentioned did not reveal mycelia. as possibilities: (1) aphthous stomatitis, (2) moniliasis, (3) eruption due to drugs, (4) Behcet’s triple symptom complex and (5) scrotal tongue. “Medical consultation revealed nothing contributory. The urine was normal; blood cell counts were normal; the results of the serologic test for syphilis and examination Examination by the gynecologic consultant showed only of the chest were all negative. Repeated cultures from the mouth lesions failed to demonstrate chronic cervicitis. Monilia, although cultures from vaginal discharge on one occasion did grow mucoid coloOn one occasion, the patient comnies with budding forms on microscopic examination. plained of soreness about the vulva, and examination in our department revealed superficial ulcerations about the labia minora and majora. “On about the first of February, the patient was found to have decided infection of the right conjunctiva diagnosed as episcleritis by the ophthalmologic consultant. This was considered consistent with, though not diagnostic of, Behcet’s syndrome of the eye. She stated that she had had one previous similar, though less severe, attack of ocular inflammation about five weeks ago.” *Chicago
Dermatological
Society.