Table 1.

Timeline of the episodes of care

	Day 1	Day 2	Day 4
Place	Gynecology ER	General ER	Gynecology ER
Clinical findings	Vulvar papules and edema, fever 39.5 °C, inguinal adenopathy	Blurred vision, persistent genital lesions, lumbar pain, recurrent fever 39 °C; decreased visual acuity, suspicion of retinal hemorrhages	Painful deep genital ulcerations, dysuria, urinary retention, persistence of blurred vision; patient is concerned about vulvar lesions; has not been to an ophthalmologist yet Fundoscopic examination shows parafoveolar microhemorrhages and whitish lesions of the retina; OCTA: microangiopathy of the retina
Laboratory results	PCR swabs for HSV of vulvar lesions sent to the laboratory	Leukocytosis 13.9 G/L, CRP 204 mg/L, CSF culture, hemocultures, serologies all normal; PCR swabs of vulvar lesions negative	–
Suspected diagnosis	HSV-2 primo-infection	Possible side effect of valaciclovir	Inaugural Behçet’s disease
Decision	Discharged with oral valaciclovir and NSAID	Switch to acyclovir, patient advised to consult an ophthalmologist	Admitted for in-patient stay, urinary catheter, pulsed methylprednisolone 500 mg/day

On the first line, day after onset of first symptoms

ER emergency room, OCTA optical coherence tomography angiography, PCR polymerase chain reaction, CSF cerebrospinal fluid, HSV herpes simplex virus, NSAID nonsteroidal antiinflammatory drugs, LC leucocytes, CRP C reactive protein