Behcet's Disease in an Indian Patient Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh

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 Nodular lesions over penis and scrotum Mouth ulcer

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

Bilateral Panuveitis in Behcet's Disease 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