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From questions on page 1034
1. What is the diagnosis of the patient based upon her ocular and systemic symptom constellations?
Oral aphthae, genital ulcers and hypopyon uveitis, namely “triple symptom complex” or “classical triad,” defines Behçet disease (BD), which was described first by a Turkish dermatologist, Dr Hulusi Behçet, from Istanbul in 1937.1 It is a chronic, relapsing, multisystemic idiopathic inflammatory problem with episodic occlusive retinal vasculitis2 and is thought to be mediated by a variety of cytokines, including tumour necrosis factor (TNF)-α.3 Although BD also affects the children at a mean age of onset between 4 and 13 years with a similar course in adults, the eye is the most commonly involved internal organ during the course of BD, and anterior with or without posterior segment inflammation may develop in up to 90% of cases whether the report originated from ophthalmology, dermatology or rheumatology departments.2 4 Therefore, the case presented here was diagnosed as BD with ocular involvement.
2. What kind of ocular and/or systemic treatment schedule would you first prescribe when you encounter such a patient?
Treatment schedule: Colchicine was continued,2 4 and anterior uveitis was treated with topical CS drops three to six times a day (dexamethasone 0.1%) during the day and ointments at bedtime, which was increased to every 30 min when hypopyon was encountered that was gradually tapered to 24, 12 and four times daily once the inflammation was under control. Topical diclofenac was also added as a potentiator of CS activity along with short-acting mydriatic and cycloplegic agents thrice a day.
Despite treatment with corticosteroids (CSs) at a daily dose of 1 mg/kg, …