How would you approach peri-operative immunosuppressive management of a patient with Behcet's, currently controlled on azathioprine, who needs genital surgery?

It might be helpful to know what kind of genital surgery is planned and why.

Here are a few general thoughts: There are little data to guide a unified approach outside of BD patients who need vascular surgery. Standard rules of thumb are to 1) reduce surgeries to a necessary minimum and 2) regard most non-vascular surgery as reasonably safe in patients who are inactive on immunosuppression or old enough to have little risk of BD activity. The latter is a bit tricky as patients with non-PA arterial aneurysms (who have a very high surgical risk for vascular and may have an increased risk for non-vascular surgery) often tend to be somewhat older. Not having had BD symptoms in years and being older than 60 likely confers little BD-attributable ...

Agree with Dr. @Dr. First Last. While I don't use the pathergy testing approach described, it certainly has merit. Given potential pathergy in patients with relatively low infectious risk due to immunosuppression like in this case, I continue immunosuppression through surgery.