Abstract

P 301

Granulomatous scleritis in association with Behcet’s disease

Anne Wissen, Johann Roider, Bernhard Nölle
Klinik für Ophthalmologie, Universitätsklinikum Schlewig-Holstein, Campus Kiel, Kiel

Objective
Approximately 50% of all cases of scleritis are associated with systemic diseases. Behcet’s disease (BD) is rarely one of them. We report the case of a recurrent necrotizing, granulomatous scleritis being the ocular manifestation of vasculitis due to Behcet’s disease.
Methods
Case report.
Results
A 46-year-old man with the diagnosis of an undifferentiated small vessel vasculitis since 09/2001. In 2006 he has been diagnosed with Behcet’s disease. The history of his immunosuppressive medication includes methotrexate, cyclophoshamide, azathioprine and cyclosporine A. Regular ophthalmological examinations were performed since 10/2002 and did not show any abnormalities. In 06/2007 he developed a sectoral, anterior scleritis with a central, necrotizing granuloma on the right eye despite of the treatment with oral prednisolone 8mg/day, cyclosporine A 350mg/day and azathioprine 100mg/day. His eye condition improved after continuing the immunosuppressive drugs, increasing corticosteroids to 60mg/day and adding topical dexamethasone. In 09/2007 he experienced a recurrent event of granulomatous scleritis of the right eye as well as arthralgia, myalgia and renal insuffiency when prednisolone was trying to be reduced to7,5mg/day. Therefore, the prednisolone dose was again increased to 60mg/d. Under a bolus therapy of cyclophosphamide followed by a maintenance therapy a remission of the scleritis was seen leaving an circumscribed scleromalacia. Over the course of time, the above mentioned immunosuppressive therapy was reduced and then continued by infliximab every 6 weeks and leflunomide 20mg/day. A few years later the patient presented a cataracta complicata which was operated without any complications (OD 01/09, OS 11/08).
Conclusions
It is possible that a granulomatous scleritis can be an ocular mono symptom of Behcet’s disease. Systemic, highly dosed treatment with a combination of immunosuppressive drugs is required for a successful therapy. The addition of systemic infliximab to the immunosuppressive therapy seems to be effective and has so far prevented further relapses.

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