RIFABUTIN INDUCED VITRITIS IN AIDS PATIENTS

The authors report three patients with the acquired immunedeficiency s yndrome (AIDS) who developed uveitis while prophylactically taking rif abutin (300 mg/kg or more), clarithromycin and fluconazole. The uveiti s presented unilaterally, but became bilateral within seven days in ea ch patient. Inflammation was more severe in the vitreous than in the a nterior chamber. Examination of the vitreous and blood from one patien t with microbiological smears, bacterial and fungal culture and the po lymerase chain reaction (PCR) to herpesviruses did not reveal an infec tious etiology. Discontinuation or decreasing the dose of rifabutin to 300 mg/day and treatment with topical steroids and cycloplegics resul ted in resolution of the uveitis within two weeks. Our findings suppor t the observation that prophylactic doses of rifabutin, combined with clarithromycin, fluconazole or other agents which can increase rifabut in levels, can induce uveitis in patients with AIDS. It is important t o recognize that a severe vitritis which can obscure visualization of the retina can be solely attributed to rifabutin in patients with AIDS . Therapy requires lowering the dose of rifabutin and the use of topic al corticosteroids and cycloplegics.