Beh

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Behçets Disease A Case of Peripheral Ulcerative
Keratitis Leading to Corneal Perforation

• Selcuk Sizmaz, Aysel Pelit, Meltem Yagmur, Didem
  Arslan, Yonca Aydin Akova

None of the authors have any financial or
proprietary interest in any material used in the
study
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• 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-oclock quadrant
• No sign of dry eye
• Topical ofloxacin and artificial tears prescribed

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• Three days later, signs worsened
• Thinning involved the posterior stroma
• Patient declined surgery

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• Two days later
• Corneal perforation
• Iris prolapsed

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• Corneal patch graft and amniotic membrane
  transplantation

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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

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Erithrocyte sedimantation rate 35 mm/h
C-reactive protein 4.5 mg/L (?)
HBV (-)
HCV (-)
HIV (-)
ANA (-)
C-ANCA (-)
HLA-B27 (-)
HLA-B51 (-)

• 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 (-)

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Diagnosis Behçets disease

• Oral aphthous lesions
• Ocular involvement
• Large vessel vasculitis
• Sacroiliitis

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• Management
• Methylprednisolone, 32 mg/day, po tapered
• Azathioprine, 150 mg/day, po
• Prognosis (1 year follow-up)
• No recurrence
• Systemic symptoms improved

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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