Behets Disease A Case of Peripheral Ulcerative Keratitis
Behçet’s Disease: A Case of Peripheral Ulcerative Keratitis Leading 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
• Two days later – Corneal perforation – İris prolapsed
• Corneal patch graft and amniotic membrane transplantation
Ophthalmic and systemic evaluation • 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 (mm. Hg) – 130/80 right arm – 100/70 left arm • Weak pulse in left arm • Colour Doppler USG: left subclavian artery narrowing • MR angipgraphy: 4 cmlong diffuse stenosis in left subclavian artery • Sacroiliac graphy: grade II -III sacroiliitis • Pathergy test: (-) Erithrocyte 35 mm/h sedimantation rate C-reactive protein 4. 5 mg/L (↑) HBV (-) HCV (-) HIV (-) ANA (-) C-ANCA (-) HLA-B 27 (-) HLA-B 51 (-)
Diagnosis: 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 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
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