We report the case of a 17-year-old male presenting with recurrent, debilitating oral and genital ulcerations. Diagnostic evaluation confirmed multisystemic Behçet's syndrome with multifocal intestinal involvement. Following the exclusion of infectious contraindications, the patient was initiated on upadacitinib (15 mg daily) as a primary systemic intervention. Remarkable clinical remission of mucocutaneous and gastrointestinal ulcerations was achieved within 1 month. Sustained improvement was observed during subsequent follow-up, suggesting that upadacitinib may serve as an effective therapy for multisystemic Behçet's syndrome in adolescent patients.

Pemphigus vulgaris (PV) is an autoimmune blistering disease that may present predominantly with mucosal involvement and is frequently misdiagnosed as infectious or inflammatory conditions. We describe a 72-year-old Filipino woman with a 3-month history of painful oral and genital ulcerations and subsequent flaccid bullae who was initially diagnosed and treated sequentially for candidiasis, disseminated herpes zoster infection, and Behçet's disease based on International Criteria for Behçet's Disease scoring. Despite multiple antimicrobial therapies, her symptoms progressed. Definitive evaluation revealed intraepidermal acantholysis on histopathology and intercellular IgG and C3 deposition in a characteristic "fishnet" pattern on direct immunofluorescence, with positive desmoglein 1 and 3 antibodies, confirming PV. Prompt initiation of systemic corticosteroids led to rapid clinical improvement. This case underscores how diagnostic anchoring and reliance on classification criteria can delay recognition of autoimmune blistering disease, highlighting the need for early biopsy and direct immunofluorescence in persistent mucocutaneous ulceration.

In November 2020, an alert for a "mysterious disease" among fishermen was issued. Fishermen are particularly subjected to dermatoses due to their constant contact with seawater, fish, crustaceans, and fishing equipment that may contain harmful agents. The study aimed to examine the alert, identify the causative agent and suggest preventive and control measures. This was a cross-sectional study of dermatoses in Dakar (Senegal) from October 11 to November 30, 2020, using quantitative and qualitative methods within a 'One Health' approach." The investigation included bacterio-virological, anatomopathological and toxicological examinations. Data were analyzed using Epi info and QGIS (case mapping), We observed all confidentiality measures during the study. A total of 555 cases were diagnosed with an attack rate of 5.4% among fishermen and no deaths were reported. There was a delay in epidemic detection and notification. The epidemic was most prevalent among people from coastal areas. Average age of cases was 22 ± 9 years, and all were male and artisanal fishermen by profession. Patients presented with fever (16%), cutaneous pain (100%) and mucocutaneous lesions (100%) consisting of vesicles, papules and ulcerations localized on exposed areas of the body, external genitalia and oral mucosa, with severe cases (8%). Toxicology revealed the presence of a toxic alga (V. rugosum) in marine equipments. The notion of a sea trip in the 24-48 hours before the onset of the disease was found in 92%. Majority of cases (74%) did not have full personal protective equipment (PPE). The proportion of people without full protection was 83% among those who developed severe forms. People without full protection were more exposed to severe forms than those with full PPE; (OR = 1.818; 95% CI [0.829 - 3.988]). The investigation has linked the epidemic to a probable algal origin. We need to promote the use of personal protective equipment and improve the early warning and notification system.

Behçet's disease (BD) is a rare, chronic, and multisystemic vasculitis characterized by recurrent oral and genital ulcers, uveitis, and skin lesions. Although vascular involvement is common in BD, pulmonary manifestations are rare and potentially fatal. Among these, pulmonary thromboembolism (PTE) represents an exceptional event, as deep vein thrombosis (DVT) in BD usually remains adherent to the vessel wall and seldom embolizes to the lungs. We report a 52-year-old male with BD who presented with a four-day history of progressive dyspnea, productive cough, and new-onset hemoptysis. He had been in clinical remission for one year after discontinuing colchicine therapy. On admission, his oxygen saturation was 90% on room air, with inspiratory crackles on auscultation. Laboratory findings revealed leukocytosis, elevated inflammatory markers, and a markedly increased D-dimer level. CT pulmonary angiography demonstrated multiple filling defects in the right main and segmental pulmonary arteries without evidence of pulmonary artery aneurysm (PAA). Anticoagulation with heparin was initiated. However, during hospitalization, the patient developed oral and genital aphthous ulcers, indicating disease relapse. Immunosuppressive therapy with cyclophosphamide and prednisolone led to significant clinical improvement. This case underscores the importance of maintaining a high index of suspicion for PTE in BD and highlights the necessity of distinguishing BD-related thrombosis from conventional embolic events, as management requires a combination of immunosuppressive and anticoagulant therapy to prevent fatal complications.

Cutaneous tuberculosis is an uncommon extrapulmonary manifestation of Mycobacterium tuberculosis infection. Vulvar involvement is an exceptionally rare clinical entity that poses significant diagnostic challenges due to its similarity to other dermatologic and gynecologic conditions. We present the case of a 25-year-old immunocompetent woman with an 18-month history of a vulvar and perineal lesion that developed over the scar of a previous episiotomy. The patient was initially managed for a recurrent bacterial soft-tissue infection and received multiple antibiotic regimens without a therapeutic response. Upon admission, a raised, erythematous, granulomatous plaque with fistulization was observed. Definitive diagnosis was established through histopathological examination, which revealed chronic granulomatous inflammation and a Ziehl-Neelsen stain positive for acid-fast bacilli. To further complement the diagnostic workup, an interferon-gamma release assay was performed and was reactive; the tuberculin skin test was deferred due to the patient's prior BCG vaccination. Standard four-drug antituberculous therapy was initiated, resulting in a favorable clinical evolution. Vulvar tuberculosis should be considered in the differential diagnosis of chronic, ulcerated, or granulomatous genital lesions unresponsive to conventional antibiotic therapy, particularly in patients from endemic areas. Early clinical suspicion and timely biopsy are crucial to prevent morbidity associated with delayed diagnosis.

We conducted a cross-sectional study to estimate the prevalence of urogenital and extragenital sexually transmitted infections (STIs) among men who have sex with men (MSM) with and without urethral discharge syndrome, to assess infections missed by syndromic management, and to describe phenotypic antimicrobial susceptibility patterns of Neisseria gonorrhoeae. The study included 189 MSM attending the Engage Men's Health Clinic in Johannesburg, South Africa, in 2024. Urethral, rectal and oropharyngeal swabs were tested by multiplex PCR for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV). Genital ulcer swabs were tested for HSV-1/2, lymphogranuloma venereum (LGV), Haemophilus ducreyi (HD) and Treponema pallidum (TP). Serological diagnostic testing for HIV, hepatitis B virus (HBV) and syphilis was performed. NG isolates underwent culture and antimicrobial susceptibility testing. Among MSM with urethritis, NG was most prevalent (urethra: 80.3%, rectum: 41.7%), followed by CT (urethra: 14.8%, rectum: 11.7%). Pharyngeal NG was more common among MSM with urethritis than those without (18.0% vs 3.1%, p = 0.001). Among MSM without urethritis, rectal NG and CT prevalence were 13.5% and 9.5%; rectal LGV was detected in three cases. Among 22 participants with genital ulcers, an aetiology was identified in eight: HSV-2 (n = 3), TP (n = 4) and LGV (n = 1). All NG isolates were susceptible to ceftriaxone, cefixime, and azithromycin, and had low MICs of gentamicin. HIV, HBsAg and treponemal antibody seroprevalence were 31.4%, 3.2% and 50.8%. Active syphilis (RPR titres ≥1:32) was more frequent among MSM without urethral symptoms. Among MSM with urethritis, CT infection was less likely in those reporting recent insertive oro-anal sex and HIV pre-exposure prophylaxis (PrEP) use. Among MSM without urethritis, any discharge STI was associated with homosexual orientation, HIV positivity and lack of circumcision, NG with HIV positivity and being uncircumcised and CT with HIV positivity. Extragenital and asymptomatic STIs remain common among MSM in Johannesburg, stressing the need for routine multi-site molecular screening and inclusion of rapid serological syphilis testing in national STI guidelines for key populations.

The coexistence of Behçet's syndrome (BS) and myelodysplastic neoplasm (MDS) is increasingly recognized and is often referred to as MDS with BS-like features. These patients demonstrate a distinctive profile characterized by a high prevalence of trisomy 8 and limited response to conventional immunosuppressive therapy. However, the mutational profile of this rare entity remains almost entirely unexplored. Here, we report a 36-year-old female presenting with painful oral and genital ulcers who is subsequently diagnosed with an atypical form of BS. Nonetheless, whole-exome sequencing identified monoallelic TP53 and SF3B1 mutations, findings highly indicative of MDS. After confirmation of diagnosis and prognostic assessment, the patient ultimately underwent successful allogeneic stem cell transplantation. This case highlights the importance of comprehensive genomic profiling in diagnosing, risk-stratifying, and managing patients with rare hematological entities presenting with autoinflammatory phenomena.