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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
History
 22 year old male
 OU:
 defective vision since 3 months
 photophobia since 3 months
 H/o oral and genital ulcers
 H/o joint pain
 painful skin lesions
First Presentation
 VA: OD 6/6, OS 6/6
 IOP: OD 10mm Hg; OS 14mm Hg
 OU:
 non-granulomatous KP's
 AC 2+ cells; flare 2+; AVF occ. cells
 fundus: disc edema with hyperaemia
Skin lesions
 multiple, discharging pustules over the body
 multiple pigmented, excavated scars on the back, face and
limbs
Mouth and Genital lesions
Mouth ulcer
Nodular lesions
over penis and
scrotum
Polyarthritis
 H/o multiple joint
swelling and pain
 Swelling of left ankle
 Swelling of finger joints
First Presentation – Ocular Findings
 OU:
 non-granulomatous KP's
 AC 2+ cells; flare 2+;
 vitreous cells 2+ in the
lower quadrant
 fundus: disc edema with
hyperaemia, retinal
infiltrates
Investigations
 Routine baseline investigations within
normal limits
 ESR – 50mm – 1st hr
 Mantoux & TPHA -ve
 LFT - normal
Diagnosis
Bilateral Panuveitis in
Behcet's Disease
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
Follow Up – After 6 weeks




No oral ulcer
VA: OD 6/6, OS 6/12
IOP: OD 17mm Hg; OS 17mm Hg
OU:
 quiet eye, resolution of uveitis
 patient was continued on oral therapy
Follow-up – After 8 Months
 OU: recurrence of 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:intense vitreous cell reaction in lower
quaderant
Treatment for both 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 available for him
Final Presentation - findings
 Aug 2010 – Jul 2014:
 recurrence of panuveitis with Behcet´s Disease
 oral therapy (Steroids and
Immunosuppresants)
 Intravitreal Triamcinolone acetonide
 VA: OD 6/6 OS 6/18 no active inflammation
 Diminished vision (OU) due to ERM at
Macula (OS>OD)
Complications during Treatment




due to concomitant medications:
fungal ulcer
skin ulcer (lumbar region)
methotrexate stopped during drug
associated complication period(s)
Conclusion
 Bilateral Panuveitis in Behçet's Disease
 systemic disease affecting young males of 2.-3. decade
 presents with oral and genital ulcer, ocular
involvement, skin lesions and + pathergy test
 early diagnosis and appropriate treatment with
systemic steroids, immunosuppressants, but better
biologicals help to preserve vision
 recurrences are often without biologicals