we report a tanzanian male who presented with typical features of bd and was successfully treated . behcet 's disease ( bd ) is a rare immune - mediated systemic vascular disease ( named after the turkish dermatologist , hulusi behcet in 1937 ) which is characterized by the recurrent oral aphthae and other several systemic manifestations . it is believed to exist in many parts of the world with high incidences in the middle east , far east , and mediterranean region and in an area of the ancient trading route known as  old silk road  between latitudes 30 and 45 north in asia and europe . high prevalence of bd ( 420 per 100,000 ) has been reported in turkey   with lowest prevalence of 0.38 per 100,000 being reported in the north america . in sub - saharan africa , the prevalence of bd is not known but few cases have been reported elsewhere [ 46 ] , with only one case being reported from tanzania over 40 years ago . behcet 's disease is believed to be caused by autoimmune response to an infectious or environmental insult in a genetically predisposed individual . bd typically presents in the third and fourth decade of life with no specific sex predilection . there are no pathognomonic investigative tests for the disease , and thus , the diagnosis relies on the clinical criteria according to the international study group for the behcet 's disease ( isgbd ) . isgbd requires the presence of recurrent oral aphthae ( three times in 1 year ) with at least two of the following : recurrent genital aphthae ( aphthous ulceration or scarring ) , eye lesions ( retinal vasculitis , cells in vitreous , or uveitis ) , skin lesions ( papulo - pustular lesions , pseudo - vasculitis , acneiform nodules , or erythema nodosum ) , or a positive pathergy test . corticosteroids , immunosuppressant drugs , tumor necrosis factor - inhibitors , and other symptomatic treatments are commonly used in the management of bd . we report a case of young tanzanian male who presented with typical symptoms and signs of bd and who was successfully treated with corticosteroids alone . we are reporting a 31-year - old black tanzanian male who presented to our hospital with 2-year history of painful recurrent oral ulcers , 4-month history of scrotal lesions , and 1-week history of intermittent eyes discharge . he reported to have four recurrences in the past 1 year which were neither bleeding nor discharging . in the past 4 months prior to the current admission , he noted the lesions around his scrotum that started like pustules and later ruptured to form painful ulcers . the penis was spared . he denied history of epigastric pain , painful defecation , painful micturition , hematuria , reduced amount of urine , or any history suggestive of sexual transmitted diseases in the past . one week prior to admission , the patient noted to have mild yellowish discharge from both eyes associated with itching and foreign body sensation but not pain . over the course of his illness , the patient had neither fever nor weight loss . he reported to have had several prior admissions due to the same illness and had been treated with multiple courses of fluconazole , nystatin , and several antibiotics with no relief . he had no known history of allergy and had never been transfused with blood or blood products . all other family members were healthy and none of the other family member has similar illness . physical examination revealed young adult who was slightly wasted , full conscious , and afebrile ( 36.7c ) . he also had extensive labial - oral ulcers with patches of thrush on the throat . ophthalmologist examination revealed bilateral conjunctivitis , normal visual acuity ( 6/6 in both eyes ) , normal visual fields , and normal optic nerves but with signs of uveitis by slit lamp examination . characteristic ulcerative inflammatory lesions on the ( a ) eyelids , ( b ) mouth , and ( c ) scrotum in the index patient with behcet 's disease . the blood pressure was 120/60 mmhg , the pulse rate was 72 beats per minute regular , the respiratory rate was 18 cycles per minutes , and the oxygen saturation was 95% in room air . urogenital system examination revealed normal male genitalia with scattered wet ulcerations on the scrotum ( fig.1 ) . the results from laboratory analysis done were complete blood count ( normocytic moderate anemia with hemoglobin level of 10 g / dl and a mean corpuscular volume 87 fl . , other cells ' count were within normal ranges ) , serum for syphilis antibodies by venereal disease research laboratory ( nonreactive ) , hiv rapid serological test ( negative ) , scrotal and ocular ulcers ' swabs for gram staining ( no bacteria found ) , renal function test ( normal range ) , random blood glucose ( 5.1 mmol / l ) , and pathergy test ( negative ) . the diagnosis of bd was made according to the isgbd   basing on the presence of recurrent oral aphthae ( > 3 times in 1 year ) together with recurrent genital aphthae and posterior uveitis with conjunctivitis . we treated this patient with intravenous dexamethasone 12 mg 8 hourly for 5 days followed by oral prednisolone 30 mg 12 hourly for 30 days then tapered gradually over 30 days . we also gave erythromycin eye ointment two drops 8 hourly for 7 days . toward the end of the first week of corticosteroid therapy , the patient started improving significantly and the ulcers he was followed up in the outpatient clinic on days 30 , 60 , and 90 as well as at sixth month and 1 year and without any recurrence of the ulcers or conjunctivitis ( fig.2 ) . pictures of the ( a ) eyelids and ( b ) scrotum showing good response to therapy 1 month after the initiation of corticosteroid therapy . the prevalence of bd in sub - saharan africa is unknown but only a few cases have been reported in tanzania , south africa , ethiopia , and nigeria . in light of these reports , we assume that many cases remain undiagnosed or unreported in this region due to lack of awareness regarding bd among clinicians in this region . the long duration of speculation prior to bd diagnosis as shown in the present case ( 2 years ) and other similar case reports ( 5.5 years in comoro and 2 years in nigeria )   further exemplify the delay in diagnosis that typically results from this lack of bd awareness . our patient had typical presentation for bd according to the isgbd criteria   ( fig.1 ) , but he was initially misdiagnosed at multiple health facilities . in particular , this patient was misdiagnosed as having candidiasis and bacterial infections . in four case series of adults with bd of africa ancestry , oro - genital aphthae were found to be the most common presenting feature , as was also observed in our patient . furthermore , the age and sex of our patient ( 31-year - old male ) is similar to the patients ' mean age at the time of diagnosis reported among one case series of 14 african adults living in the union of the comoros ( 33.1  5.8 years ) with male preponderance ( 71.4% , 10/14 ) . of note , in this series from comoros , most bd patients were hla - b51 negative leading the authors to conclude that bd associated with hla - b51 negativity presents with severe manifestation with undue sequelae in east african adults as opposed to those with hla - b51 positivity in other regions . generally , bd responds well to steroids , with the combination of corticosteroids and immunosuppressant drugs being indicated when vital organs are involved . our patient responded very well to the steroids alone within 18 days of treatment with no vision sequelae as well as no systemic complications ( fig.2 ) . this case emphasizes the need to increase awareness among clinicians in sub - saharan africa on bd so as to timely diagnose and offer prompt treatment . further studies are needed to ascertain the prevalence and distribution of bd in africa as well as associated genetic factors .
key clinical messagebehcet 's disease ( bd ) is a rare condition which is diagnosed clinically . 
 only few cases have been reported in sub - saharan africa . 
 we report a tanzanian male who presented with typical features of bd and was successfully treated . 
 there should be an increase in awareness on bd to improve the management .