گزارش يك مورد پاسخ چشم‌ گير پان‌ يوئيت مقاوم بيماري بهجت به درمان كوتاه مدت با Infliximab و به‌ دنبال آن Cellcept

A case report on dramatic response of refractory panuveitis of Behcet disease to short-term therapy with Infliximab followed by Cellcept

بيماري بهجت يك سندرم واسكوليتي با درگيري چند ارگان است كه داراي ترياد كلينيكي آفت‌ هاي دهان و زخم‌ هاي تناسلي و درگيري چشمي مي‌ باشد. درگيري چشمي بيماري بهجت مي‌ تواند به سمت از دست رفتن سريع بينايي پيش برود. اين گزارش در رابطه با معرفي يك مرد 40 ساله با درگيري چشمي دوطرفه و شديد (پان‌ يوئيت مقاوم به درمان) مي‌ باشد كه ما جهت كنترل آن Infliximab را شروع كرديم و بعد از اولين تزريق وريدي پاسخ افتالمولوژيك قابل ملاحظه‌ اي مشاهده شد. بعد از سومين تزريق وريدي جهت بيمار Cellcept شروع شد. 14 ماه بعد از آخرين تزريق وريدي Infliximab وضعيت بيمار هم‌چنان ثابت مانده است.

Behcet disease (BD) is a multisystem vasculitic syndrome with clinical triad of oral aphthus ulcer, genital ulcer, and eye involvement. Uveitis of BD may be particularly resistant to corticosteroids and immunosuppressants with a rapid progression to loss of vision in 10-25% of the cases. In recent years, Infliximab is a very useful drug for refractory eye involvement of BD and some studies recommend Cellcept for this reason. Here, we reported a 40 years old man with known BD, referred to our Clinic with severe bilateral panuveitis. His eye involvement was refractory to conventional therapy in 15 months follow-up; then he was switched to Infliximab, in an attempt to control his disease. Infliximab (3mg/kg) was given at 0, 4, 8 weeks (three doses) together with Azathioprin. Very soon after the first infusion, we have found a remarkable ophthalmologic response. We have prescribed Cellcept after the third infusion and discontinued Azathioprin and Infliximab.14 months after the last infusion, no significant changes were found in ophthalmologic examination. Our observation highlights a difference in the effect of Cellcept in panuveitis of BD.