case_images: PMC11249751_01
case_images: At the initial presentation, ill-defined erythematous papules distributed across the arm (a) and back (b). c, d Four weeks later, the rashes transformed into multiple discrete erythematous indurated nodules with central ulceration. Posterior cervical and occipital lymphadenopathy was observed (black arrows). e, f Two weeks after receiving intravenous penicillin G, the ulcerative nodules began to flatten, accompanied by the resolution of the lymphadenopathy. g Epidermal erosion with perivascular and periadnexal infiltration by neutrophils, eosinophils, and plasma cells is noted. No basal vacuolar interface change is identified (H&E x100). h Immunohistochemistry for Treponema staining was positive for numerous spirochetes at the dermoepidermal junction.
case_images: cop-2024-0015-0001-539723_F01.jpg
case_images: PMC11249751_01_cop-2024-0015-0001-539723_F01.jpg
case_images: F1
case_images: Following the administration of the 56th dose of golimumab, the patient returned for a follow-up with complaints of decreased vision and the presence of ill-defined erythematous plaques with some erythematous pustular papules, primarily distributed across the trunk, neck, and extremities (Fig. 1a, b). In addition, multiple palpable lymph nodes measuring up to 1.5 cm in size were detected within the posterior cervical and occipital regions (Fig. 1c, d). T. pallidum immunostaining was positive for numerous spirochetes at the dermoepidermal junction (Fig. 1g, h). After completing a 2-week course of penicillin treatment, the ulcerative nodules began to flatten and develop scales, accompanied by resolution of the lymphadenopathy (Fig. 1e, f).
case_images: Ultra-wide-field fundus imaging of both eyes (upper) reveals end-stage Behcet's uveitis, including alterations in the retinal pigment epithelium, pale disc, vascular attenuation, and gliotic vessels. A macular scar is observed in the left eye. Spectral domain optical coherence tomography of both eyes (lower) demonstrates atrophic retina with disrupted outer segments. In the left eye, hyperreflectivity corresponds with a scar at the retinal pigment epithelium-Bruch's membrane complex.
case_images: cop-2024-0015-0001-539723_F02.jpg
case_images: PMC11249751_01_cop-2024-0015-0001-539723_F02.jpg
case_images: F2
case_images: Fundus examination and optical coherence tomography of the macula revealed an improvement in vitreous haze, and findings consistent with end-stage Behcet's uveitis remained unchanged in both eyes (Fig. 2).