skip to main content

Behcet Posterior Uveitis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisBehcet Posterior UveitisSCE Rheumatology

A 50-year-old man with established Behçet's syndrome (recurrent oral and genital ulceration, previous erythema nodosum) reports three days of rapidly worsening vision in both eyes. Visual acuity is 6/36 right and 6/24 left. Dilated fundoscopy and optical coherence tomography confirm active bilateral posterior uveitis with occlusive retinal vasculitis and macular oedema. Infection, including tuberculosis and syphilis, has been excluded, and he has received no previous systemic therapy for ocular disease. Which is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intravenous methylprednisolone followed by infliximab and a corticosteroid taper

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E

Bilateral posterior uveitis with occlusive retinal vasculitis and macular oedema is acute sight-threatening Behçet's eye disease. EULAR advises high-dose (usually intravenous) glucocorticoid induction combined with infliximab (or interferon-alpha, which is not generally available in Europe) for an initial or recurrent sight-threatening attack, because monoclonal TNF inhibitors control ocular inflammation more reliably and rapidly than conventional immunosuppressants; adalimumab is an accepted alternative in UK practice. Topical corticosteroid and cycloplegic drops (D) do not reach therapeutic posterior-segment levels and are the classic trap when the affected segment is overlooked. NSAIDs (B) have no disease-modifying role, and observation (A) risks irreversible visual loss within days. Methotrexate alone (C) acts too slowly and lacks efficacy data here; azathioprine or ciclosporin are conventional options only for milder, non-sight-threatening disease.

Reference: 2018 update of the EULAR recommendations for the management of Behçet's syndrome — ocular disease/uveitis recommendations, Annals of the Rheumatic Diseases 2018;77:808–818. https://pubmed.ncbi.nlm.nih.gov/29625968/