Intranasal pain in a patient with Behçet’s disease

A 52 year old woman with Behçet’s disease presented with two to three days of severe pain in her left nostril. She had Behçet’s associated bowel, oral, and cerebral vasculitis and had been taking prednisolone for 20 years.

She reported occasional bouts of aphthous stomatitis (a known complication of Behçet’s disease) inside her mouth and on her lips, face, and hands, and said that topical corticosteroid was effective in these instances.

She also stated that blisters that were different from the aphthous ulcers sometimes appeared on her face, lips, and inside her mouth when the dose of steroid increased; these responded well to topical aciclovir so were assumed to be herpes simplex virus (HSV).

Six …