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.