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Pustule and erythema at the site of a sterile needle prick
    Differential Diagnosis[Top] [Nav]
Behçet disease
    Discussion -- not available online[Top] [Nav]
    Update Comments[Top] [Nav]
  • This overview of Behçet disease for residents says:
    Skin pathergy is a criterion for the diagnosis of Behçet's disease and is manifested clinically by an area of erythematous induration of 2 mm or larger at the site of a needle stick. Pathergy is maximally visible by 48 hours and resolves in 4 to 5 days. Erythema without induration is considered a negative test result. When used in conjunction with other diagnostic criteria, the sensitivity and specificity of skin pathergy in detecting Behçet's disease range from 71 to 100% and 86 to 98%, respectively.
  • In contrast to Hooten's paper, cites Ozarmagan's paper and says "the skin hyper-reactivity reaction, long held to be pathognomonic of Behçet's disease, is of limited value as a diagnostic tool." [106]
  • Favorably reviewed in Mayo Clin Proc 1989;64:1199. [109]
  • "Lesions of pyoderma gangrenosum often follow a minor injury, a sequence known as pathergy." [110]
  • Pathergy in pyoderma gangrenosum is clinically distinct from the needle test used in Behçet disease: "Typically [in pyoderma gangrenosum], often in response to slight trauma, an erythematous nodule or acneiform lesion appears... and rapidly ulcerates, commonly enlarging to over 10 cm in diameter, with satellite ulcers forming around the initial lesion." [111]
  • In this case report, a "history of formation of a sterile abscess at the site of a tetanus injection suggested pathergy." [112]
    Footnotes in Print Edition[Top] [Nav]
    (1) Textbook of Rheumatology. 2nd ed.
  Kelley WN, et al. Philadelphia: Saunders, 1985: 409, 1174-1178.
    (2) Behcet's disease.
  Wong RC, Ellis CN, et al.   Int J Dermatol 1984 Jan-Feb;23(1):25-32.  Pubmed+Abstract  Similars
    (3) Recent Advances in Behçet's Disease. Royal Society of Medicine Services International Congress and Symposium Series No. 103.
  Lehner T, Barnes CG (eds). London: Royal Society of Medicine, 1986: 169-172 [Dilsen N, et al. Standardization and evaluation of the skin pathergy test in Behçet's disease and controls.].
    (4) A comparative study of the pathergy reaction among Turkish and British patients with Behcet's disease.
  Yazici H, Chamberlain MA, et al.   Ann Rheum Dis 1984 Feb;43(1):74-5.  Pubmed+Abstract  Similars
    (5) The usefulness of the nonspecific skin hyperreactivity (the pathergy test) in Behcet's disease in Turkey.
  Tuzun Y, Yazici H, et al.   Acta Derm Venereol 1979;59(1):77-9.  Pubmed+Abstract  Similars
    (6) The Impact of Illness on World Leaders.
  Park BE. Philadelphia: University of Pennsylvania Press, 1986: 159.   Amazon.com
    New References[Top] [Nav]

    101.Comparative study of the skin pathergy test with blunt and sharp needles in Behcet's disease: confirmed specificity but decreased sensitivity with sharp needles.
  Dilsen N, Konice M, et al.   Ann Rheum Dis 1993 Nov;52(11):823-5.  Pubmed+Abstract  Similars
    102.Effect of surgical cleaning of the skin on the pathergy phenomenon in Behcet's syndrome.
  Fresko I, Yazici H, et al.   Ann Rheum Dis 1993 Aug;52(8):619-20.  Pubmed+Abstract  Similars
    103.Re-evaluation of the pathergy test in Behcet's disease.
  Ozarmagan G, Saylan T, et al.   Acta Derm Venereol 1991;71(1):75-6.  Pubmed+Abstract  Similars
    104.Sensitivity and specificity of pathergy test results in Israeli patients with Behcet's disease.
  Friedman-Birnbaum R, Bergman R, et al.   Cutis 1990 Apr;45(4):261-4.  Pubmed+Abstract  Similars

Behçet disease
    105.29-year-old man with recurrent deep venous thrombosis and skin lesions.
  Hooten WM, O'Duffy JD.   Mayo Clin Proc 1998 May;73(5):463-6.  Pubmed  Similars
    106.A mechanic who coughed up blood for 15 months.
  Buchanan JA, Morris A, et al.   Lancet 1997 Jul 5;350(9070):28.  Pubmed  Similars
    107.Behcet's syndrome [editorial; comment].
  O'Duffy JD.   N Engl J Med 1990 Feb 1;322(5):326-8.  Pubmed  Similars
    108.Behçet's Disease: Basic and Clinical Aspects.
  O'Duffy JD, Kokmen E (eds). New York: Dekker, 1991: 696 pp.
    109.Behçet's Disease: A Contemporary Synopsis.
  Plotkin GR, et al. Mount Kisco, NY: Futura, 1988: 312 pp.

Other causes of pathergy
    110.Pyoderma gangrenosum [see comments].
  Callen JP.   Lancet 1998 Feb 21;351(9102):581-5.  Pubmed  Similars
    111.Pyoderma gangrenosum and its treatment [see comments].
  Powell RJ, Holbrook MR, et al.   Lancet 1997 Dec 13;350(9093):1720-1.  Pubmed  Similars
    112.A new autosomal dominant disorder of pyogenic sterile arthritis, pyoderma gangrenosum, and acne: PAPA syndrome.
  Lindor NM, Arsenault TM, et al.   Mayo Clin Proc 1997 Jul;72(7):611-5.  Pubmed+Abstract  Similars
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:33 PDT on July 4, 2000.[Top]

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