Download - Behçet’s Disease: A Case of Peripheral Ulcerative Keratitis Leading to Corneal Perforation
Behçet’s Disease: A Case of Behçet’s Disease: A Case of Peripheral Ulcerative Keratitis Peripheral Ulcerative Keratitis Leading to Corneal PerforationLeading to Corneal Perforation
Selcuk Sizmaz, Aysel Pelit, Meltem Yagmur, Didem Arslan, Yonca Aydin Akova
• A 27 year-old man• Two day history of redness in the right eye• Corneal thinning involving the anterior
stroma and adjacent conjunctival hyperemia, in the corneal limbus, at the 2- to 3-o’clock quadrant
• No sign of dry eye• Topical ofloxacin and artificial tears
prescribed
• Three days later, signs worsened– Thinning involved the
posterior stroma– Patient declined
surgery
Ophthalmic and systemic Ophthalmic and systemic evaluationevaluation
• No significant ocular history• Oral aphthous lesions that had occurred
once or twice a month for the previous 2 years
• Eight years history of lower back and buttock pain with morning stiffness for 30 minutes
• Arthralgia in the knee joints without swelling
• Arterial BP (mmHg)– 130/80 right arm– 100/70 left arm
• Weak pulse in left arm• Colour Doppler USG: left
subclavian artery narrowing
• MR angipgraphy: 4 cm-long diffuse stenosis in left subclavian artery
• Sacroiliac graphy: grade II-III sacroiliitis
• Pathergy test: (-)
Erithrocyte sedimantation rate
35 mm/h
C-reactive protein 4.5 mg/L (↑)
HBV (-)
HCV (-)
HIV (-)
ANA (-)
C-ANCA (-)
HLA-B27 (-)
HLA-B51 (-)
Diagnosis: Behçet’s diseaseDiagnosis: Behçet’s disease
• Oral aphthous lesions
• Ocular involvement
• Large vessel vasculitis
• Sacroiliitis
• Management:– Methylprednisolone, 32 mg/day, po; tapered– Azathioprine, 150 mg/day, po
• Prognosis (1 year follow-up):– No recurrence– Systemic symptoms improved
Differential diagnosisDifferential diagnosis• Takayasu arteritis
+ Aorta and branches involved– No aphthous lesions– Sacroiliitis uncommon– Ocular invovement rare
• Polyarteritis nodosa+ Peripheral ulcerative keratitis occurs– Predominantly females– Aneurisms in small-middle sized vessels– Constitutional symptoms