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Behcet Sight-Threatening Uveitis — SCE Rheumatology MCQ

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HardVasculitisBehcet Sight-Threatening UveitisSCE Rheumatology

A 45-year-old man with Behcet disease develops sudden painful visual loss. Ophthalmological examination reveals panuveitis with retinal vasculitis and hypopyon (pus in the anterior chamber). What is the most urgent treatment?

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Correct answer: C — Systemic high-dose immunosuppression (IV Methylprednisolone followed by oral steroids plus immunosuppressive such as Azathioprine Ciclosporin or anti-TNF) to prevent irreversible visual loss

Panuveitis with retinal vasculitis and hypopyon in Behcet disease is an ophthalmological emergency requiring urgent systemic immunosuppression. Topical therapy alone is insufficient for posterior segment disease. High-dose glucocorticoids (IV Methylprednisolone followed by oral taper) combined with a steroid-sparing immunosuppressive (Azathioprine Ciclosporin or anti-TNF agent such as Infliximab or Adalimumab) are required. BSR/BAD 2024 Behcet guidelines emphasise the risk of irreversible retinal damage and blindness without prompt aggressive treatment. Anti-TNF agents have shown particular efficacy for sight-threatening Behcet uveitis.

Reference: BSR/BAD 2024 Behcet living guideline