Fuchs’ uveitis masquerading as a Behçet related anterior uveitis

• Published in: Acta ophthalmologica (Oxford, England) Vol. 95; no. S259
• Main Authors: Claeys, M., Sys, C., Leroy, B.P., De Schryver, I.
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01.09.2017
• Subjects: Acuity; Anterior chamber; Arthralgia; Azathioprine; Behcet's syndrome; Case reports; Congenital rubella; Corticoids; Corticosteroids; Eye; Fatigue; Genomes; Immunomodulation; Inflammation; Mimicry; Polymerase chain reaction; Rubella; Scars; Toxoplasmosis; Uveitis; Visual acuity
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2017.0T075

Purpose To report a case of a Turkish patient with Behçet disease and a recurrent unilateral uveitis. Methods Observational report of a case of Behçet disease with unilateral anterior uveitis in the left eye (LE). The anterior inflammation was considered as part of the clinical spectrum of Behçet disease. The patient underwent an extensive ophthalmological work‐up. Results A 37‐years‐old male Turkish patient presented with an unilateral panuveitis. The Behçet's diagnosis was based on the criteria published by the international study group for Behçet's disease. At presentation the patient reported fatigue, recurrent oral ulcerations and arthralgia. Ophthalmolgical work‐up revealed a visual acuity of 4/10 in the LE. Slit lamp study showed cells in the anterior chamber (AC), vitritis and periflebitis. The panuveitis, refractory to local therapy, was treated with systemic corticosteroids and azathioprine. The posterior inflammation responded well. The anterior segment (AS) showed a chronic, recurrent low‐grade inflammation refractory to conventional immunomodulatory therapy during 8 months. Based upon the therapy‐resistant AS inflammation, the typical diffuse fine stellate keratic participates and the absence of posterior synechiae, the diagnosis of fuchs’ uveitis was suspected. Fundoscopy of the right eye showed hyperpigmented chorioretinal scars, previously related to toxoplasmosis. The clinical picture was highly suggestive for a congenital rubella infection. Conclusions To our knowledge this is the first case of a patient with Behçet's disease associated to Fuchs’ uveitis. The refractory anterior inflammation mimicking a Behçet's related AS uveitis is a diagnostic challenge. Ophthalmological work‐up should include an AC punction with Polymerase Chain Reaction to rule out a possible viral genome. As in Hickam's Dictum, one pathology can masque another.