Peripheral Ulcerative Keratitis: Another Ocular Manifestation of Behçet's Disease

Ocular involvement in Behcet's Disease (BD) is typically characterized by uveitis, which is present in over 50% of cases. However, more and more cases of corneal involvement are reported. We report a rare case of Peripheral Ulcerative Keratitis (PUK) associated with Behçet's disease. This is a 38-year-old man who has been followed for Behçet's disease for 5 years, in remission and without treatment for one year and without overt anterior ocular involvement, who presented a deep ulcerative lesion with a peri-lesional disorder in the nasal peripheral cornea of the left eye on a background of moderate dry eye. Initial visual acuity was 13/20 without correction and there was no anterior chamber reaction or posterior segment involvement. Because of the worsening of the ulcer despite 3 days of treatment with antibiotics and antivirals, the diagnosis was reconsidered given the patient's history of BD and a course of topical and oral corticosteroids and wetting agents were instituted. The evolution was spectacular, after 5 days of treatment, with visual acuity back to 20/20 and almost complete healing, thus confirming the etiology of this keratitis. Any marginal ulcer, especially one that is refractory to antibiotics and antivirals, should be investigated for Behçet's disease.