Topics:
Rheumatology • Vasculitis
How would you approach peri-operative immunosuppressive management of a patient with Behcet's, currently controlled on azathioprine, who needs genital surgery?
The patient has not responded/has contraindications to apremilast, colchicine, and adalimumab. When they were off azathioprine for 5 days in the past, they got genital ulcers, which may interfere with healing.
Answer from: at Academic Institution
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 m...
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Answer from: at Academic Institution
Agree with Dr. @Nowatzky. 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.