title: Multi-drug resistance and side-effects in a patient with Behçet's disease.
abstract: OBJECTIVE
  To report on the clinical course of ocular and extraocular involvement in a multidrug-resistant patient with Behçet's disease (BD).
  
  
  METHODS
  A 22-year-old male with BD (bilateral panuveitis and retinal vasculitis, oral ulcers, erythema nodosum, arthralgia, epididymitis) was followed-up from 1999 to 2014. He was treated continuously with corticosteroids in combination with different immunosuppressive therapies (cyclosporine, azathioprine, methotrexate, interferon, infliximab, mycophenolate), which exerted numerous side-effects such as nephrotoxicity, nephrolithiasis, increase of liver enzymes, severe depression with suicidal ideation, severe leucopenia, pulmonary tuberculosis, pulmonary legionellosis, recurrent bronchopneumonia.
  
  
  RESULTS
  Despite immunosuppressive and corticosteroid therapies, the patient showed multiple relapses of uveitis and systemic BD lesions and developed severe osteoporosis with multiple vertebral fractures, bilateral cataracts and steroid-associated glaucoma until 2007. Since then he has been treated with prednisone alone, currently at low dosage, remaining free from uveitis and systemic symptoms. His final visual acuity is 9/10 in the right eye and counting fingers in the left one.
  
  
  CONCLUSIONS
  BD patients are usually responsive to immunosuppressive drugs. The possibility of a multi-drug resistance as well as of multiple drug-related side effects cannot be disregarded and continuous therapy should be given in order to preserve a useful visual acuity until the disease, either spontaneously or drug-induced, runs into remission.
authors.affiliation: Centro di Riferimento Regionale Malattia di Behçet, Azienda Policlinico Umberto I, "Sapienza" Università di Roma, Rome, Italy. massimo.accorinti@tiscali.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Accorinti
authors.affiliation: Centro di Riferimento Regionale Malattia di Behçet, Azienda Policlinico Umberto I, "Sapienza" Università di Roma, Rome, Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Pesci
authors.affiliation: Centro di Riferimento Regionale Malattia di Behçet, Azienda Policlinico Umberto I, "Sapienza" Università di Roma, Rome, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Pirraglia
authors.affiliation: Dipartimento di Reumatologia, "Sapienza" Università di Roma, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Priori
authors.affiliation: Centro di Riferimento Regionale Malattia di Behçet, Azienda Policlinico Umberto I, "Sapienza" Università di Roma, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Pivetti-Pezzi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D001528:Behcet Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents