Clinical case for residents(IV) 29-year-old man with abdominal pain, ascites, and mucocutaneous lesions

Abstract

This document is part of the Clinical Cases for Residents collection, a teaching project aimed at postgraduate training in Rheumatology and also applicable to other medical specialties involved in the management of systemic diseases. Its purpose is to strengthen clinical reasoning skills, syndromic analysis, and the structured development of differential diagnoses in complex clinical scenarios.

The case presents the comprehensive evaluation of a 29-year-old man with subacute abdominal pain, hepatomegaly, ascites, systemic inflammation, and mucocutaneous manifestations suggestive of a multisystem vasculitic process. A detailed discussion of the differential diagnoses is provided, with particular emphasis on the reasoning that supports Behçet disease–associated Budd–Chiari syndrome as the most likely diagnosis. The document outlines the key elements necessary for clinical interpretation, the complementary tests required—especially vascular imaging—and the underlying pathophysiological considerations.

The case is designed as a teaching tool for medical residents, with activities focused on group discussion, structured diagnostic reasoning, and the integration of clinical, analytical, and imaging findings. It forms part of a collection intended to reinforce advanced competencies in differential diagnosis, integrative clinical analysis, and evidence-based decision-making in real-world clinical practice.