Behçet’s disease in non-endemic areas: a delayed diagnosis in a young male with recurrent bipolar aphthosis

Introduction: Behçet's disease (BD) is a rare chronic multisystem inflammatory disorder characterized by vasculitis of vessels of any caliber. It is classically associated with populations along the ancient Silk Road (from the Mediterranean basin to the Far East), but increasing numbers of cases are now reported in non-endemic regions, where delayed diagnosis is common due to low clinical suspicion and the absence of specific diagnostic biomarkers. Case description: We report the case of a 28-year-old man from Mexico with an 18-month history of recurrent painful oral ulcers, later associated with genital ulcers, arthralgias, and cutaneous lesions. The patient had been previously evaluated by multiple physicians and received several empirical treatments without improvement. Physical examination revealed multiple oral and genital ulcers, erythematous macular lesions on the palms and soles, and acneiform lesions on the back. Laboratory and immunological studies were unremarkable, and ophthalmological evaluation was normal. After exclusion of infectious and autoimmune diseases, Behçet's disease was suspected. The patient met the International Criteria for Behçet's Disease (ICBD, 2014) with a total of 5 points. Treatment with azathioprine and prednisone led to progressive clinical improvement. Conclusion: This case highlights the diagnostic challenges of Behçet's disease in non-endemic regions. Awareness of its heterogeneous clinical spectrum and the use of validated clinical criteria are essential to avoid diagnostic delay and prevent irreversible organ damage. LEARNING POINTS: Behçet's disease should be suspected in patients with recurrent bipolar aphthosis, even in non-endemic regions.The absence of specific biomarkers and histological findings contributes significantly to delayed diagnosis.The International Criteria for Behçet's Disease (ICBD, 2014) provide a sensitive and practical clinical tool for recognizing incomplete but clinically relevant forms of the disease.