Challenging case: “If it looks like a duck, swims like a duck and quacks like a duck… It’s not always a duck”
Purpose
To report a case of Behçet’s disease simulating acute retinal necrosis (ARN) syndrome
Methods
single case report
Results
A 32-year-old male with no significant medical history presented with a complaint of blurred vision, redness, and pain in his left eye (OS). On examination, his visual acuity was 20/20 in his right eye (OD) and light perception in OS. Anterior segment examination of OS revealed micro-granulomatous keratic precipitates, 1+ cell reaction in the anterior chamber, iris rubeosis, and posterior synechiae. Dilated fundoscopy of OS showed dense vitritis with peripheral area of retinal whitening and subretinal detachment. OD examination was unremarkable. The diagnosis of OS ARN was made and anterior chamber tap with polymerase chain reaction of varicella zoster virus and herpes simplex virus came back negative and the patient was treated with intravenous acyclovir. At follow-up, we noticed the presence of OD vitritis and an angiography showed diffuse capillaritis. We diagnosed ARN bilateralisation and antiviral treatment was maintained. One month later the patient developed inflammatory retinal vein occlusion with multifocal retinitis. General examination showed the presence pseudofolliculitis. The diagnosis of Behçet’s disease was made. The patient was treated with a high dose of oral corticosteroids and azathioprine. One month later, visual acuity was 20/200 in OD and no light perception in OS.
Conclusion
Although granulomatous involvement is exceptional in Bechet’s disease, recognizing the clinical features of retinal fluorescein angiography notably the “the fern-like appearance” remain capital.
Conflict of interest
No
Authors 1
Last name
MAAMOURI
Initials of first name(s)
Rym
Department
OPHTHALMOLOGY
City
TUNIS
Country
Tunisia
Authors 2
Last name
Ferchichi
Initials of first name(s)
M
Department
OPHTHALMOLOGY
City
Tunis
Country
Tunisia
Authors 3
Last name
Somai
Initials of first name(s)
M
Department
Internal medicine
City
Tunis
Country
Tunisia
Authors 4
Last name
Mhalla
Initials of first name(s)
S
Department
microbiology
City
MONASTIR
Country
Tunisia
Authors 5
Last name
Boussema
Initials of first name(s)
F
Department
Internal medicine
City
TUNIS
Country
Tunisia
Authors 6
Last name
Cheour
Initials of first name(s)
M
Department
OPHTHALMOLOGY
City
Tunis
Country
Tunisia
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