How would you approach the workup and management of a young patient with recurrent biannual non-scarring oral ulcers and new onset neurologic symptoms with associated CNS white matter lesions concerning for Behcet’s?

This is a challenging case. It should be noted that oral ulcers in Behcet's typically occur more than twice per year (by ISG criteria should occur at least 3x per year) and without other symptoms of BD it can be very challenging to make a probable diagnosis of BD in this scenario. A careful history and exam with attention to other possible manifestations of BD is critical. The following aspects would be helpful in evaluating the likelihood in this case.

1. Are the ulcers aphthous by appearance and has HSV been ruled out as a cause?
2. Is the radiographic pattern of brain lesions suggestive of BD? BD characteristically involves the brainstem/midbrain, basal ganglia, and diencephalon.
3. What is the cellular pattern of the CSF? BD can have a neutroph...