Behçet Syndrome

  • Diagnosis
  • Algorithms
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • Mucocutaneous ulcers associated with systemic symptoms

Criteria for Diagnosis

Laboratory Testing

Other Tests

  • Pathergy test – intradermal injection of skin with 20 gauge needle using normal saline
    • Positive test – demonstrates erythematous sterile papule within 48 hours

Differential Diagnosis 

Behçet syndrome is a multisystem, chronic inflammatory disease that is usually characterized by oral ulcers, genital ulcers, and uveitis. It is categorized as a variable vessel vasculitis when vasculitis is found to be present (Chapel Hill, 2012).


  • Incidence – 1-2/100,000 in U.S.
  • Age – 20-40 years
    • Rare in children or  individuals >50 years
  • Sex – M>F in Mediterranean populations; M<F in Asian and U.S. populations
    • Young males tend to have the most severe disease
  • Ethnicity – rare in the U. S.
    • Much higher incidence in Mediterranean and Middle Eastern populations


  • HLA-B51 strongly associated with disease
    • Frequently expressed in individuals who live along the Silk Route (Mediterranean to Far East)
      • Association between HLA-B51 and Behçet syndrome not established outside of the Silk Route
    • Associated with severe disease manifestations, including posterior uveitis or progressive central nervous system disease

Risk Factors

  • Genetics
    • HLA-B51
  • Environmental exposures


  • Vascular injury to arteries and veins of all sizes – exact cause unknown
    • Small vessel disease most common
    • Venous involvement may present as thromboembolic disease
    • Arterial aneurysms
  • Abnormal cellular immune responses and lymphocyte functions

Clinical Presentation

  • Disease severity varies
    • Middle Eastern countries – disease most severe in young men with severe uveitis common
    • U.S. – disease most severe in women and uveitis less common
  • Constitutional – fever, fatigue, malaise
  • Mucocutaneous – recurrent oral (aphthous ulcers) and genital ulcers (most common sign)
    • Must recur >3 times/year to meet International Study Group Criteria (1990)
  • Musculoskeletal – peripheral arthritis, myositis, enthesitis
  • Neurologic – headache, confusion, strokes, personality changes, dementia (rare), aseptic meningitis, papilledema, dural sinus thrombosis, parenchymal brain disease
  • Dermatologic – erythema nodosum, papulopustular lesions, acneiform nodules, pathergy (rare in U.S.), superficial thrombophlebitis, leukocytoclastic vasculitis, pyoderma granulosum
  • Gastrointestinal – ulcers predominate in ileum and colon, emesis, diarrhea
  • Ophthalmologic – anterior/posterior uveitis (bilateral disease common), hypopyon, retinal scars
  • Otorhinologic – paranasal sinus disease
  • Bronchopulmonary – aneurysms of arteries in the lungs
  • Cardiac – pericarditis, myocarditis, valvular disease
  • Vascular – deep venous thrombosis, Budd-Chiari, arterial aneurysm
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Anti-Neutrophil Cytoplasmic Antibody with Reflex to Titer and MPO/PR-3 Antibodies 2002068
Method: Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Multiplex Bead Assay


American Society for Clinical Pathology. Choosing Wisely - Five Things Physicians and Patients Should Question. An initiative of the ABIM Foundation. [Last revision Feb 2015; Accessed: Jan 2016]

Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013; 65(1): 1-11. PubMed

General References

Hatemi G, Yazici Y, Yazici H. Behçet's syndrome. Rheum Dis Clin North Am. 2013; 39(2): 245-61. PubMed

Krause I, Weinberger A. Behçet's disease. Curr Opin Rheumatol. 2008; 20(1): 82-7. PubMed

Mat C, Yurdakul S, Sevim A, zyazgan Y, Tüzün Y. Behçet's syndrome: facts and controversies. Clin Dermatol. 2013; 31(4): 352-61. PubMed

Saadoun D, Wechsler B. Behçet's disease. Orphanet J Rare Dis. 2012; 7: 20. PubMed

Singer O. Cogan and Behcet syndromes Rheum Dis Clin North Am. 2015; 41(1): 75-91, viii. PubMed

Yazici H, Fresko I, Yurdakul S. Behçet's syndrome: disease manifestations, management, and advances in treatment. Nat Clin Pract Rheumatol. 2007; 3(3): 148-55. PubMed

Medical Reviewers

Last Update: October 2016