[Case of neuro-Behçet disease with homonymous quadrantanopsia due to an inflammatory lesion involving the lateral geniculate body].

We report a rare case of a 57-year-old woman of neuro-Behcet disease with homonymous quadrantanopsia due to an inflammatory lesion involving the lateral geniculate body. She had oral and genital ulcers since 1983, and uveitis since May 1985. She received diagnosis of incomplete Behcet disease and was prescribed cyclophosphamide since June 1985. After the treatment, she recovered completely from uveitis in July 1985. Painful subcutaneous nodules appeared in her right leg on June 21, 2004 and she had a high fever, headache and left visual disturbance on June 29, 2004. Therefore, she was admitted to our hospital on July 1, 2004. Physical and neurological examination showed erythema nodosum in the right lower extremity and left lower homonymous quadrantanopsia. Laboratory findings on admission showed leucocytosis, increased erythrocyte sedimentation rate and C-reactive protein, and positive HLA-B51. Cerebrospinal fluid analysis showed pleocytosis and a markedly high level of protein and interleukin-6. Brain magnetic resonance imaging (MRI) of T2-weighted images showed high intensity lesions in the circumference of the caudal thalamus, optic radiations, and right occipital cortex. T1-weighted images with gadolinium enhancement showed an enhanced lesion in the circumference of the right lateral geniculate body. From these results, she was diagnosed as having an acute relapsing phase of neuro-Behcet disease and she received steroid pulse therapy. Immediately after steroid pulse therapy, she received high-dose prednisolone which was gradually tapered. Brain MRI after treatment showed a high intensity lesion in the right lateral geniculate body. Homonymous quadrantanopsia remained nearly unchanged.