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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
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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
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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
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Skin lesions multiple, discharging pustules over the body
multiple pigmented, excavated scars on the back, face and limbs
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Mouth and Genital lesions
Nodular lesions over penis and scrotum Mouth ulcer
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Polyarthritis H/o multiple joint swelling and pain
Swelling of left ankle Swelling of finger joints
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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
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Investigations Routine baseline investigations within normal limits
ESR – 50mm – 1st hr Mantoux & TPHA -ve LFT - normal
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Bilateral Panuveitis in Behcet's Disease
Diagnosis Bilateral Panuveitis in Behcet's Disease
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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
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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
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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
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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
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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)
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Complications during Treatment
due to concomitant medications: fungal ulcer skin ulcer (lumbar region) methotrexate stopped during drug associated complication period(s)
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Conclusion Bilateral Panuveitis in Behçet's Disease
systemic disease affecting young males of 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
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