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I would like to thank International Team for the Revision of the International Criteria for Behçet's Disease (ICBD).[1] As the mortality of the disease was reported higher in patients with the vascular and neurologic involvement,[2] the addition of neurological and vascular manifestations to the diagnostic criteria in ICBD will permit early referral of these patients to expert centres. On the other hand, I have doubts about the false diagnosing of the disease with scoring four points or above. Prevalence of recurrent aphthous stomatitis derived from hospital-based studies was ranging from 1% to 66% among adults and 1% to 40% among children.[3] Ulcus vulvae acutum is one of the most genital aphtosis I see in my daily practice. In addition to Epstein-Barr virus, Cytomegalovirus, Mycoplasma pneumonia and Influenza A virus have also been implicated in the pathogenesis of ulcus vulvae acutum.[4] Many of these patients also have recurrent aphthous stomatitis. According to ICBD diagnostic criteria, they could be accepted as falsely having Behçet's Disease. In my opinion, accepting points not equal but higher than four would be better in proper diagnosis of Behçet's disease as mentioned in Table 6 of the original article that score of five points is accepted as ‘highly likely BD’.[1]

References

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  • 1
    International Team for the Revision of the International Criteria for Behçet's Disease (ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. JEADV 2014; 28: 338347.
  • 2
    Kural-Seyahi E, Fresko I, Seyahi N et al. The long-term mortality and morbidity of Behçet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center. Medicine (Baltimore) 2003; 82: 6076.
  • 3
    Chattopadhyay A, Shetty KV. Recurrent aphthous stomatitis. Otolaryngol Clin North Am 2011; 44: 7988.
  • 4
    Sardy M, Wollenberg A, Niedermeier A, Flaig MJ. Genital ulcers associated with Epstein-Barr virus infection (ulcus vulvae acutum). Acta Derm Venereol 2011; 91: 5559.