Tuberculosis Masquerading as Behcet's Disease-Pseudo Bechet's Syndrome: A Case-Based Review of Literature

Behcet's disease is a chronic, multisystem variable vessel vasculitis characterised by recurrent oral and genital ulcers, ocular inflammation and a wide range of systemic manifestations. Pseudo-Behcet's syndrome refers to a condition that mimics these clinical features but arises from distinct etiologies. We present a case of a 33-year-old male with year-long recurrent oral ulcers and intermittent abdominal pain, followed by scrotal ulcers, severe fatigue, weight loss and appetite loss. Chest imaging demonstrated bilateral consolidations with cavitation and right-sided pleural effusion, prompting consideration of a Behcet's mimic. Thoracoscopic pleural biopsy revealed acid-fast bacilli, confirming tuberculosis. A diagnosis of Pseudo-Behcet's secondary to tuberculosis was made. Initiation of anti-tubercular therapy led to complete resolution of symptoms within 4 months. A literature review identified nine cases (including the index case) in which tuberculosis presented with Behcet's-like features, underscoring the complex association between Behcet's disease and tuberculosis. This case underscores the need to consider tuberculosis as a Behcet's disease mimic, particularly in endemic areas, to prevent misdiagnosis and inappropriate immunosuppression.