Gastrointestinal Behҫet's disease mimicking appendicitis

A woman in her 40s of Chinese and African American ancestry with medical history of severe Behҫet's disease on immunosuppressive therapy presented with right lower quadrant abdominal pain. CT of the abdomen and pelvis suggested appendicitis. General surgery recommended bowel rest and antibiotics for treatment, considering her a high surgical risk due to her history of Behҫet's disease and immunosuppression. She again presented 2 weeks later with nausea, vomiting, worsening pain, fever, leucocytosis and elevated inflammatory markers. Colonoscopy was pursued with concern for appendicitis versus possible Behҫet's disease flare, which revealed colonic aphthous ulcers and a large caecal ulcer with associated oedema and ulceration of the appendiceal orifice, consistent with ileocaecal Behҫet's disease. Antibiotics were discontinued, and she was treated with systemic glucocorticoids with complete resolution of her presenting symptoms. Behҫet's disease may convincingly mimic appendicitis, and colonoscopy may prevent unnecessary appendectomy in patients with such a presentation.