Refractory Ocular Behçet’s Disease; Outcome of Low Dose Infliximab

Document Type: Case Report

Authors

1 Modern One Stop Arthritis Care and Research Center®(MOAC&RC®), Dhaka Department of Medicine, MH Samorita Hospital and Medical College

2 Modern One Stop Arthritis Care and Research Center®(MOAC&RC®), Dhaka, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU)

3 Modern One Stop Arthritis Care and Research Center®(MOAC&RC®), Dhaka

4 Bangladesh Eye Hospital, Dhaka,

5 1Modern One Stop Arthritis Care and Research Center®(MOAC&RC®), Dhaka

6 Professor at the Department of psychology and communication of health, Faculty behavioral sciences and philosophy University, Twente, Netherland

Abstract

A 40-year-old woman had been suffering of many symptoms of Behçet’s disease (BD) since her childhood without being diagnosed. She had recurrent mouth ulcers and from the age of 21 vulva ulcers followed by loss of vision due to central retinitis and later also ankle arthritis. At the age of 31, uveitis due to BD was diagnosed. The fact that BD is often not recognized in Bangladesh explains the marked delay in her diagnosis. The initial central retinitis responded well to oral glucocorticoids, azathioprine and cyclosporine, but in the course of time she became refractory to these agents. Considering her financial constraints, low dose Infliximab (3mg/kg) was used resulting in a remarkable but temporal improvement, she came in remission by using 5mg/kg regimen with increased interval time.
We summarize the treatment options for ocular involvement in BD patients
Conclusions: In countries like Bangladesh diagnosis of Behçet’s disease can be delayed. Early cooperation of dermatologists and eye surgeons with rheumatologists is necessary. Most cases of resistant ocular BD can nowadays be successfully treated with anti TNF-agents. Promising results are published with other biologics for refractory and multi-resistant cases.

Keywords

Main Subjects