A 30-year-old male presented with painful, deep recurrent oral aphthous ulcers. O/E ulcers had a yellowish necrotic base and appeared in crops, painful genital ulcers and skin lesions were also seen. A test was also done by the doctor wherein he injected normal saline intradermally. On ophthalmoscopic examination, B/L panuveitis was noted. Patient also complained of ahralgia in B/L knee joint. Lab findings revealed leukocytosis, raised ESR and raised CRP. Which of the following antibodies can be seen in the above condition: – ASCA Ab ANCA Ab Ab against ALPHA-ENOLASE Ab against selenium binding protein Anti-histone Ab

**Core Concept**
The patient's presentation of painful, recurrent oral aphthous ulcers, painful genital ulcers, skin lesions, panuveitis, and arthralgia, along with laboratory findings of leukocytosis, raised ESR, and CRP, is suggestive of Behçet's disease. Behçet's disease is a form of vasculitis that affects multiple systems, including the mouth, skin, eyes, and joints.

**Why the Correct Answer is Right**
The correct answer is Ab against Alpha-enolase. Alpha-enolase is an enzyme that is involved in glycolysis, but it also has a role in the inflammatory process, particularly in Behçet's disease. Studies have shown that patients with Behçet's disease have higher levels of anti-alpha-enolase antibodies, which may contribute to the pathogenesis of the disease. This is distinct from other forms of vasculitis, such as ANCA-associated vasculitis, which is associated with antibodies against proteinase 3 or myeloperoxidase.

**Why Each Wrong Option is Incorrect**
* **Option A:** ASCA Ab (Anti-Saccharomyces cerevisiae antibody) is associated with Crohn's disease, a type of inflammatory bowel disease. While gastrointestinal symptoms can occur in Behçet's disease, the presence of ASCA Ab is not specific for Behçet's.
* **Option B:** ANCA Ab (Anti-neutrophil cytoplasmic antibody) is associated with ANCA-associated vasculitis, which typically presents with kidney or lung involvement. While Behçet's disease can involve multiple organs, the presence of ANCA Ab is not characteristic of this condition.
* **Option C:** Ab against selenium binding protein is not a well-established marker for any specific disease. While selenium binding protein has been implicated in various inflammatory conditions, it is not a specific or sensitive marker for Behçet's disease.
* **Option D:** Anti-histone Ab is associated with drug-induced lupus erythematosus, a condition that presents with symptoms similar to systemic lupus erythematosus but is triggered by medication. While Behçet's disease can involve multiple organs, the presence of anti-histone Ab is not characteristic of this condition.

**Clinical Pearl / High-Yield Fact**
Behçet's disease is a form of vasculitis that affects multiple systems, including the mouth, skin, eyes, and joints. It is characterized by the presence of oral aphthous ulcers, genital ulcers, and skin lesions, as well as systemic symptoms such as arthralgia and panuveitis. The diagnosis of Behçet's disease is typically made based on clinical criteria, and the presence of anti-alpha-enolase antibodies may be a useful adjunctive marker.

**Correct Answer:** . Ab against Alpha-enolase

✓ Correct Answer: C. 1, 3 and 4