Case Report
About one and a half years ago, a 38-year-old married male Nepalese
serving soldier presented to our center with complaints of diminution of
vision of the left eye for three days. His visual acuities were 6/24 in
OS (Oculus Sinister) and 6/6 in OD (Oculus Dextrus). Intraocular
pressure (IOP) was 13 and 12 in OS and OD, respectively. On
ophthalmological examination of the left eye, 4+ cells, 2+ flare, blue
dot cataract, 3+ vitreous cells, and snow banks were noted. In addition,
there were multiple lesions with arteritis in the fundus. The findings
of the right eye were unremarkable. There were no abnormalities on
systemic examination. With the diagnosis of uveitis (anterior and
intermediate), the patient was prescribed prednisolone and atropine eye
drops.
On further inquiry, he had a history of recurrent episodes of oral
ulceration for several months that was aggravated for the last one week.
His past medical history revealed the episodic occurrence of genital
ulcers a few years back. So, for detailed evaluation, the patient was
referred to Dermatology outpatient department (OPD), where a panel of
investigations was sent. His routine blood investigations were normal.
Differential diagnoses included aphthous ulcer, secondary syphilis,
oro-mucosal lichen planus, psoriasis vulgaris, systemic lupus
erythematosus, and Behcet’s Disease. To rule out these differential
diagnoses, further investigations were sent. VDRL, TPHA , ANA, Anti DS
DNA, HLA B27, and HLA B25 came out to be negative. However, he was
positive for HLA B51.
Pathergy test was done, which showed a positive result. According to
International Criteria for Behcet Disease (ICBD) criteria, all these
features were diagnostic of Behcet disease. The patient was then started
on oral Methotrexate 15 mg once a week along with oral folic acid 5 mg
once weekly. Likewise, the oral ulcer was symptomatically treated with
oral saline gargle,
quadrajel(Lidocaine,
Chlorhexidine Gluconate, and Metronidazole), oroheal gel(Triamcinolone
Acetonide 0.1%w/w), zinc, and vitamin C supplements. Since the
diagnosis, the patient has been on follow-up regularly with different
complaints at different times, as mentioned in table 1.