Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Ocular, neurological or major vascular Behcet disease
Painful visual loss, retinal vasculitis, cerebral venous thrombosis, parenchymal neurological disease, pulmonary-artery aneurysm or major venous thrombosis can cause blindness, brain injury or fatal haemorrhage.
Action: Arrange same-day ophthalmology, neurology or vascular assessment, obtain targeted MRI, venography or CT angiography, and begin specialist high-dose glucocorticoid plus immunosuppression; do not anticoagulate pulmonary aneurysm blindly.
Synopsis
Recognise Behcet disease from recurrent mucosal ulceration with ocular, skin, vascular, neurological and gastrointestinal inflammation, exclude infection and mimics, and treat organ-threatening disease through specialist multidisciplinary pathways.
Behcet disease is a clinical diagnosis: recurrent painful oral ulcers plus genital ulcers or scars, eye inflammation, characteristic skin lesions, vascular, neurological or gastrointestinal disease forms the pattern.
No single blood or genetic test confirms Behcet disease; HLA-B51 supports population susceptibility but has insufficient diagnostic specificity.
Document oral and genital lesions with consent, frequency, scarring and negative infection tests; ask directly because lesions may have healed before review.
Key red flags
A painful photophobic eye, floaters or reduced vision requires same-day slit-lamp and retinal assessment because posterior uveitis can rapidly blind.
Ocular inflammation
Photophobia, floaters, blurred vision or field change may indicate anterior or posterior uveitis and occlusive retinal vasculitis.
Investigation priorities
01
Clinical criteria and lesion documentationFirst step
Establish recurrence and combine mucosal, ocular, skin, vascular and neurological evidence.
Management branches
First-line diagnosisBuild the recurrent multisystem pattern
Recurrent oral ulcers coexist with genital, ocular, skin, vascular, neural or gut features.
Document episode frequency, photographs, scars and objective specialist findings and screen sexual, medicine, bowel and inflammatory mimics.
Obtain baseline blood and organ tests and urgently image or refer any eye, neurological, vascular or abdominal red flag.
Vascular emergencyTreat vessel inflammation before routine anticoagulation
Major venous thrombosis, pulmonary aneurysm or arterial occlusion occurs.
Key medicines
Topical triamcinolone oral pasteWhere specialist local supply is available, apply a small amount of triamcinolone acetonide 0.1% dental paste to each dried oral ulcer two to four times daily after meals and at bedtime for up to seven days.
ColchicineStart 500 micrograms orally twice daily and increase only if needed and tolerated, commonly to a maximum 1.5 mg/day under specialist review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.