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How can tuberculosis and Behcet's diseases be treated?

Q: My 29 years old brother, who stays in London, has been suffering from Behcet’s disease for the last 4-5 months. Later on he got lung infection. The doctors there could not specify the main problem. He suffered from high body temperature ( up to 106.5 0F at night and around 103/40F during the day), non-stop cough (at times he could not even breath properly), vomiting, weight loss (he has lost 25 kg in the last 4 months, from 85 kg to 60 kg; his height being 5'8") and anaemia . Just a month ago, a doctor confirmed he has Tuberculosis and his lungs have been severely affected (he has a blockage in one lobe). Though they treated him for TB he did not improve, rather his condition has deteriorated. Some days back, the doctors told us that he has TB in his bone and Behcet’s disease in his leg. They started high dose steroids again (eight tablets a day) and they want to continue this for the next six months. Is my brother getting the right treatment?

A:I am very sorry to hear about what your brother has been going through. Behcet's syndrome is a relatively rare disease that involves many systems . The disease manifestations come and go and vary in severity. The diagnosis is clinical and the treatment sometimes involves immunosuppression using medications like prednisone. Unfortunately that also increases the risk for infections to attack like tuberculosis. Treatment for both is generally required. The things you can do are to make sure that your brother has been seen by an expert in Behcet's disease . This is generally a rheumatologist . They can make sure that alternate diagnoses like familial Mediterranean fever are ruled out. There is a website by an organization that is a resource for patients with Behcets disease : www.behcets.com which have some additional resources . Hopefully his doctors can adjust the dose of the steroid till the TB is controlled and then focus on the Behcets. Lung involvement can also occur in Behcets with pulmonary artery aneurysms and I am sure his doctors are aware of this . All the best and hope this information is helpful to you .

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