From Retinal Vasculitis to Stroke, from Systemic Findings to Diagnosis, the Necessity of Multidisciplinary Management
Sayena Jabbehdari1, Anthony Oganov2, Sami H Uwaydat1
1Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Behçet
Area of Science:
- Rheumatology
- Ophthalmology
- Neurology
Background:
- Behçet's disease (BD) is a rare, chronic multisystem disorder characterized by occlusive vasculitis.
- Diagnosis can be challenging, especially in low-prevalence populations, with ocular and neurological manifestations being key indicators.
Observation:
- A 40-year-old female presented with vision changes and a history of strokes, later developing genital ulcers.
- Retinal vasculitis and ischemia were noted, and a genital ulcer biopsy confirmed Behçet's disease.
Findings:
- A multidisciplinary approach involving ophthalmology, rheumatology, and neurology was initiated.
- Treatment with corticosteroids and immunosuppressive therapy stabilized ocular and systemic symptoms.
Implications:
- Behçet's disease should be considered in vasculitis cases, even in low-prevalence areas.
- Early rheumatology referral and multidisciplinary collaboration are crucial for diagnosis and management to prevent complications.
Introduction:
Behçet's disease (BD) is a rare, chronic multisystem disorder characterized by occlusive vasculitis, which can present with a variety of systemic and ocular manifestations. The diagnosis of BD is often challenging, particularly in populations with low prevalence. Retinal vasculitis and stroke can be key indicators, and the early involvement of a multidisciplinary team is essential for accurate diagnosis and management to prevent long-term complications.
Case Presentation:
A 40-year-old African American female presented with vision changes in her left eye and a history of multiple strokes. Examination revealed retinal ischemia and vasculitis, raising suspicion of an underlying systemic condition. Extensive workup for infectious and inflammatory causes was negative. As her condition progressed, the patient developed genital ulcers, prompting further investigation. A biopsy of the genital ulcer confirmed BD, and a multidisciplinary approach involving ophthalmology, rheumatology, and neurology was initiated. The patient was treated with high-dose corticosteroids, immunosuppressive therapy, and intravitreal corticosteroids, leading to stabilization of her ocular and systemic symptoms. Despite her history of stroke, the collaboration between specialties facilitated better management of her condition and prevention of further complications.
Conclusion:
It is crucial to include BD as a potential diagnosis in cases of ophthalmic or systemic vasculitis, even in regions and populations with low prevalence. Early referral to a rheumatologist for cases of vasculitis and timely collaboration are essential for accurate diagnosis, prevention of systemic complications, and appropriate management.
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