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

2. 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

3. 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

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-granulomatous KP's
AC 2+ cells; flare 2+;
vitreous cells 2+ in the lower quadrant
fundus: disc edema with hyperaemia, retinal infiltrates

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

9. Bilateral Panuveitis in Behcet's Disease
Diagnosis
Bilateral Panuveitis in Behcet's Disease

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:
quiet eye, resolution of uveitis
patient was continued on oral therapy

12. 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

13. 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

14. 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)

15. Complications during Treatment
due to concomitant medications:
fungal ulcer
skin ulcer (lumbar region)
methotrexate stopped during drug associated complication period(s)

16. 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