A 28-year-old man with a history of recurrent oral and genital ulcers presents with acute posterior uveitis manifesting as vitritis inflammation, retinal vasculitis, and branch retinal artery occlusions. Regarding the systemic and ocular features of his likely diagnosis, all of the following statements are true EXCEPT:

Question

Accepted Answer

B. Retinal neovascularization and vitreous hemorrhage are rare complications requiring urgent intervention. ## Behçet Disease: Ocular and Systemic Features

**Key Point:** Behçet disease is a chronic, relapsing systemic vasculitis with significant ocular involvement. Retinal neovascularization and vitreous hemorrhage are NOT rare—they are common and serious complications that frequently occur and require urgent management.

### Behçet Disease: True vs. False Statements

| Statement | Accuracy | Explanation |
|-----------|----------|-------------|
| **Ocular involvement more common in males** | **TRUE** | Males have more severe ocular disease; female predominance overall in systemic disease |
| **Posterior > anterior segment involvement** | **TRUE** | Posterior uveitis (vitritis, vasculitis) is more frequent and severe than anterior uveitis |
| **Oral ulcers in ~100% of patients** | **TRUE** | Oral aphthous ulcers are the most common mucocutaneous feature and diagnostic criterion |
| **Neovascularization & VH are rare** | **FALSE** | These are COMMON and SERIOUS complications; occur in ~50% of patients with posterior involvement |

### Ocular Manifestations of Behçet Disease

**Anterior Segment:**
  - Anterior uveitis (non-granulomatous or granulomatous)
  - Hypopyon (pathognomonic when present)
  - Keratic precipitates

**Posterior Segment (more severe):**
  - Vitritis inflammation (often dense)
  - Retinal vasculitis (arteries and veins)
  - Branch and central retinal artery/vein occlusions
  - **Retinal neovascularization** (common, ~40–50%)
  - **Vitreous hemorrhage** (common, ~30–40%)
  - Optic disc neovascularization
  - Optic atrophy (late)

**High-Yield:** Behçet disease is the leading cause of uveitis-related blindness in young adults in endemic regions (Middle East, Mediterranean, East Asia). Posterior segment involvement is the main driver of vision loss.

**Clinical Pearl:** The presence of a hypopyon (white exudate in the anterior chamber) in a young patient with recurrent uveitis and systemic symptoms is highly suggestive of Behçet disease.

**Mnemonic: BEHÇET's Ocular Complications — VASCULAR:**
  - **V**itritis (dense inflammation)
  - **A**rteritis and **A**rtery occlusions
  - **S**evere posterior > anterior
  - **C**ommon neovascularization
  - **U**rgent vitreous hemorrhage management
  - **L**oss of vision (leading cause in young adults)
  - **A**ntibody/vasculitis-mediated
  - **R**ecurrent, relapsing course

Answer

A. Posterior segment disease is more common and more severe than anterior segment disease

Answer

C. Ocular involvement typically occurs in males more frequently than females

Answer

D. Oral ulcers are the most frequent mucocutaneous manifestation, present in nearly 100% of patients

Explanation

Practice similar questions