We present the case of a 33-year-old Caucasian woman with a diagnosis of Behcet's syndrome with severe eye disease with left optic neuropathy and bilateral retinal vaso-occlusive vasculitis. The patient had been taking subcutaneous adalimumab 40 mg every 2 weeks (for the last 6 months), cyclosporine 150 mg twice daily (for the last 12 months) and prednisolone 10 mg once daily (for the last 14 months). Before the treatment with adalimumab was initiated, she was evaluated to exclude latent or active tuberculosis: she had no suggestive symptoms or signs, chest x-ray was normal, and an interferon-gamma release assay (IGRA) and two-step tuberculin skin test were both negative. The patient also had arterial hypertension (treated with losartan 50 mg once daily) and a history of migraine.
The patient complained of odynophagia and fever for the last 2 weeks. She had already been treated with several broad-spectrum antibiotics without resolution of her symptoms. The physical examination was unremarkable except for a hypertrophied ulcerated left tonsil (Fig. 1), cervical adenopathy and fever (38oC). The patient was admitted for further investigation.