Pattern recognition is a sequential process-accurate diagnosis and treatment 20 years after presentation.

Area of Science:

• Neuro-ophthalmology
• Rheumatology
• Neurology

Background:

• Behcet's disease is a rare multisystem inflammatory disorder.
• Neurological and ocular manifestations can be severe and debilitating.
• Differential diagnosis often includes conditions like Susac syndrome and CADASIL.

Observation:

• A 25-year-old woman presented with bilateral uveitis, retinal phlebitis, vitreitis, retinal hemorrhages, and neurological symptoms including headaches and transient ischemic attacks.
• Brain MRI revealed white matter and deep grey matter lesions.
• Initial treatments with glucocorticoids and immunosuppressants failed to resolve recurrent retinal hemorrhages.

Findings:

• A detailed clinical history revealed past oro-genital ulceration, strongly suggesting Behcet's disease.
• Treatment with infliximab and methotrexate led to complete symptom resolution.
• Corticosteroids were successfully withdrawn after two decades.

Implications:

• This case underscores the importance of a thorough clinical history in diagnosing Behcet's disease.
• Effective management of neuro-Behcet's disease can be achieved with biologic agents and specific immunosuppressants.
• Early and accurate diagnosis is crucial for preventing long-term complications and improving patient outcomes.