An unusual case of Behcet disease with posterior scleritis

Abstract

Rationale:Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease.Patient concerns:A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left eye.Diagnosis:Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera.Interventions:Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12 months.Outcomes:Posterior scleritis was resolved and visual acuity improved. With the continuation of TNF-α therapy, oral prednisolone was successfully tapered and discontinued. No relapse of inflammation was observed at follow-up 1 year after discontinuation of prednisolone.Lessons:Ophthalmologists should be aware of the possibility of rare manifestation of posterior scleritis in patients with Behcet disease, and that combined use of systemic steroids and anti-TNF-α therapy may resolve the scleritis without recurrence of inflammation.

<p>Recognition, Diagnosis and Treatment of Chorioretinal Folds: Current Perspectives</p>

“…28 Resolution of CRFs have been reported in several case reports after resolution of scleritis. 24,29 These findings confirm the stressing role of a thickened sclera to the overlying layers.…”

Peripheral ulcerative keratitis: an unusual primary ocular manifestation in Behçet’s disease

“…Anterior segment features include iridocyclitis (usually as a component with panuveitis), which may be associated with a freely mobile hy- popion devoid of fibrinous exudate [4]. Conjunctival lesions, scleritis, frosted branch angiitis with or without neuroretinitis, though uncommon, may also be seen [4,11,12].…”

Choroidal folds associated with carotid cavernous fistula: a case report

“…Our case report describes a patient with a history of Behçet disease. To date, only one report has described the simultaneous presence of Behçet disease and CFs, in which the CFs were a complication of Behçet-related posterior scleritis [22] . Nevertheless, no clinical signs of posterior scleritis were noted in our patient, and this minimizes the likelihood that the observed CFs were scleritis-induced.…”