Early treatment with infliximab in bilateral occlusive vasculitis as a presenting manifestation of Behçet’ disease

Abstract

Case report

A 24-year-old woman who complained of maculo-papulo rash, genital and buccal aphthous ulcers, abdominal pain, minor dyspnea and visual loss in both eyes was presented for treatment. Funduscopy revealed a bilateral occlusive vasculitis including the central vessels. Treatment was initiated with a methylprednisolone bolus (1 g/24 h) and infliximab 5 mg/kg/day (0–2–6 weeks and every 8th week). The treatment prescribed induced a fast remission. Visual acuity improved. The patient did not suffer any other relapse after one year of follow-up.

Discussion

An initial treatment with Infliximab should be considered in Behçet disease for serious outbreaks, such as macular occlusive vasculitis with ischemia.

Resumen

Caso clínico

Mujer de 24 años con rash maculopapular, aftas orales y genitales, dolor abdominal, disnea leve y disminución de la agudeza visual en ambos ojos. La funduscopia reveló una vasculitis oclusiva bilateral que incluía los vasos centrales. Se inició tratamiento con bolos de metilprednisolona (1 g/24 h) e infliximab 5 mg/kg/día (0–2–6 semanas y cada 8 semanas).

El tratamiento indujo una rápida remisión. La agudeza visual mejoró. Tras un año de seguimiento no ha presentado ningún nuevo brote.

Discusión

Un tratamiento de inicio con infliximab debe considerarse en brotes graves de enfermedad de Behçet como una vasculitis oclusiva bilateral con isquemia.