RIFABUTIN-ASSOCIATED ANTERIOR UVEITIS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Iridocyclitis, arthralgia, and pseudojaundice have been identified as dose-dependent adverse effects in patients with acquired immunodeficie ncy syndrome (AIDS) who are treated orally with rifabutin for Mycobact erium avium intracellulare complex (MAC) infections. Nine episodes of acute anterior uveitis of varying severity ranging from mild iridocycl itis to anterior uveitis with fibrin or hypopyon, mimicking endogenous metastatic endophthalmitis, occurred in seven patients. At the time o f presentation, all seven patients were receiving rifabutin at a dose ranging from 300 to 600 mg daily. Iridocyclitis was bilateral in four of seven patients, in two cases simultaneously and in two cases succes sively. Inflammation resolved rapidly on treatment with systemic and t opical antibiotics, on corticosteroid therapy, and on discontinuation of rifabutin. In two cases of mild iridocyclitis, cessation of rifabut in alone led to resolution of the uveitis. The combination of rifabuti n, clarithromycin, and fluconazole may increase the risk for anterior uveitis in patients with AIDS. All of our patients were treated with f luconazole, with clarithromycin, or with a combination of both substan ces in addition to rifabutin. Identification of rifabutin-induced uvei tis is important because hypopyon uveitis in the immunocompromised pat ient generally evokes intensive and, sometimes, invasive ophthalmic an d systemic workup and therapy. We suggest it to be sufficient for reso lution of the inflammatory signs to discontinue rifabutin medication.