M. Schimkat et al., RIFABUTIN-ASSOCIATED ANTERIOR UVEITIS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS, German journal of ophthalmology, 5(4), 1996, pp. 195-201
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.