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A 35-Year-Old Immigrant from Turkey Comes to the Physician for Painful

question 314

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A 35-year-old immigrant from Turkey comes to the physician for painful mouth ulcers that occur frequently and are accompanied by malaise and poor appetite. He was diagnosed with "canker sores" many years ago and has tried different oral rinse solutions. He also reports muscle aches and poor sleep. One year ago, he had anterior uveitis; laboratory studies at that time revealed no abnormalities. His other medical problems include acid reflux disease, constipation, and acne. The patient takes over-the-counter antacids and fiber supplements. He has a 15-pack-year smoking history but does not use alcohol or illicit drugs.
The patient's vital signs are normal. Physical examination shows 2 large ulcers on the buccal mucosa. There are papular and pustular skin lesions on the face. He has no joint swelling or deformities. He refuses laboratory work-up because each time blood is drawn he develops "skin bumps and infection."
Which of the following conditions is the most likely diagnosis?

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