LAUSR

Background Prednisone therapy, Thalidomide, azathioprine, anti–TNF-alpha inhibitors are presently used in resistant mucocutaneous lesions of Behçet’s Disease (BD). In this study, we used only ambulatory Benzathine Penicillin (BP), without being preceded by high doses of penicillin infusion. This Study confirm the value of BP in the treatment of refractory ulcers of BD and point out a probable role of Streptococcus on the pathogenesis of BD Objectives This open Study confirm the value of BP in refractory oral, genital and skin ulcers of BD. We propose to use BP when ulcers of BD are resistant to colchicine 1.5 mg/day and to add BP in the recommendations of EULAR for the treatment of resistant cases of mucocutaneous involvement. Methods 15 patients with BD (12 patients fulfilled all criteria for BD) had Giant (mean size of ulcer superior to 1 cm), or Multiple oral, genital, skin ulcers received BP at the dose of 2.4 million units in intramuscular injection; 3 intramuscular injections with an interval of 3 weeks between injection. Colchicine at the dose of 1 mg/day was maintened. Serology of syphilis was negative. Patients had seen 15 days, 3 months and 1 year after the starting treatment. Results This study started in 2012, in a private office and comprised 15 patients:9 males; 6 females. Arthritis was observed in 11 patients, uveitis in 6 cases. BP was used in 8 patients with oral ulcers(4 Giants and 4 multiples), Genital ulcers in 3 patients (2 multiple and 1 Giant), oral and genital ulcers(2 Multiples) and cutaneous aphtosis in 2 patients 0.2 weeks after the first injection of BP, recovery from ulcers was achieved.BP was administrated a second time with success, in 9 patients who have developed resistant ulcers, after 1 to 3 years of recovery. One patient with panuveitis treated with azathioprine in 2013 and interferon alpha in 2015 and 2017, developed refractory ulcers: Excellent efficacy of BP was observed in this patient. Conclusions In this study, we confirm the recovery from refractory oral, genital and cutaneous ulcers (Giant, Multiple) in these 15 patients with BP. We recommend using more frequently BP and we propose to add BP in the recommendations of EULAR for the treatment of resistant cases of mucocutaneous involvement because treatment with BP is rather easy in outpatients, it is efficient, it has a low cost and have few side-effects References [1] Benamour S, Bettal S, Alaoui Fz and all: Treatment of Giant aphthosis by IV G Penicillin in Behçet’s disease.10 th International Conference on Behçet’s disease. Berlin, June 2002. [2] BENAMOUR S: Benzathine Penicillin in treatment of oral and Genital ulcers in Behcet’s Disease. 17th International Conference on Behçet’s Disease. Matera, 15th-17th September 2016 Disclosure of Interest None declared