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Behcet's Disease in an Indian Patient

Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika . T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh Consultant, Uveitis Service. Behcet's Disease in an Indian Patient. History. 22 year old male OU: defective vision since 3 months

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Behcet's Disease in an Indian Patient

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  1. Dr.RathinamSivakumar HOD - Uveitis Services Dr.Radhika. T Consultant, Uveitis Service Dr.Vedhanayaki Rajesh Consultant, Uveitis Service Behcet'sDisease in an Indian Patient

  2. History 22 yearold male OU: defectivevisionsince 3 months photophobiasince 3 months H/o oral and genital ulcers H/o jointpain painful skin lesions

  3. First Presentation VA: OD 6/6, OS 6/6 IOP: OD 10mm Hg; OS 14mm Hg OU: non-granulomatousKP's AC 2+ cells; flare 2+; AVF occ. cells fundus: disc edema with hyperaemia

  4. Skin lesions • multiple, discharging pustules over the body • multiple pigmented, excavated scars on the back, face and limbs

  5. Mouth and Genital lesions Nodular lesions over penis and scrotum Mouth ulcer

  6. Polyarthritis • H/o multiple joint swelling and pain • Swelling of left ankle • Swelling of finger joints

  7. First Presentation – Ocular Findings • OU: • non-granulomatousKP's • AC 2+ cells; flare 2+; • vitreouscells 2+ in thelowerquadrant • fundus: disc edema with hyperaemia, retinalinfiltrates

  8. Investigations Routine baselineinvestigationswithin normal limits ESR – 50mm – 1st hr Mantoux & TPHA -ve LFT - normal

  9. Diagnosis Bilateral Panuveitis in Behcet'sDisease

  10. Treatment Prednisolone e/d (OU) - tapering therapy Oral Prednisolone tapered weekly from 40mg/week to 10mg (4 weeks) Methotrexate 20mg/week Folic acid 6 days/week

  11. Follow Up – After 6 weeks No oral ulcer VA: OD 6/6, OS 6/12 IOP: OD 17mm Hg; OS 17mm Hg OU: quieteye, resolutionofuveitis patient was continued on oral therapy

  12. Follow-up – After 8 Months OU: recurrenceof panuveitis with oral ulcer and joint pain VA: OD 6/6, OS 6/12 IOP: OD 13mm Hg; OS 18mm Hg OU: AC – 1+ cells; AVF 2+ cells fundus: OU: disc hyperaemia OD:intensevitreous cell reaction in lower quaderant

  13. Treatment forboth Eyes Prednisolone e/d - tapering therapy oral Prednisolone tapered weekly from 40mg/week to 10mg (4 weeks) Methotrexate 20mg/week (a day) Folic acid 6 days/week intravitreal Triamcinolone acetonide (20 mg) biologicals were not availableforhim

  14. Final Presentation - findings Aug 2010 – Jul 2014: recurrenceof panuveitis with Behcet´sDisease oral therapy (Steroids andImmunosuppresants) Intravitreal Triamcinolone acetonide VA: OD 6/6 OS 6/18 noactiveinflammation Diminishedvision (OU) due to ERM at Macula (OS>OD)

  15. Complicationsduring Treatment • due toconcomitantmedications: • fungalulcer • skinulcer (lumbarregion) • methotrexatestoppedduringdrug associated complicationperiod(s)

  16. Conclusion • Bilateral Panuveitis in Behçet's Disease • systemicdiseaseaffectingyoungmalesof 2.-3. decade • presents with oral and genital ulcer, ocular involvement, skinlesionsand + pathergytest • earlydiagnosisandappropriatetreatment with systemicsteroids, immunosuppressants, but better biologicals helptopreservevision • recurrencesareoftenwithout biologicals

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