Rifabutin-associated hypopyon uveitis in human immunodeficiency virus-negative immunocompetent individuals.
OBJECTIVE
To report the occurrence of rifabutin-associated hypopyon uveitis in human immunodeficiency virus (HIV)-negative immunocompetent individuals.


METHODS
Retrospective case series.


METHODS
Three HIV-negative subjects on rifabutin and clarithromycin for Mycobacterium avium complex infections with hypopyon uveitis are described. One subject was iatrogenically immunosuppressed because of a prior lung transplant. Two subjects had no known immunosuppressive conditions.


METHODS
Topical and regional steroid therapy. Discontinuation of rifabutin was required in two subjects.


METHODS
Visual acuity, resolution of hypopyon, anterior uveitis, and vitreitis.


RESULTS
All subjects had resolution of hypopyon after therapy, two within 24 hours of beginning topical steroids. Vitreitis resolved with the discontinuation of rifabutin in two subjects. Chronic low-grade anterior uveitis and vitreitis were observed in the remaining subject, whose rifabutin dose was lowered but not discontinued because of active Mycobacterium avium complex osteomyelitis.


CONCLUSIONS
Rifabutin-associated uveitis is well described in HIV-positive individuals, but it has been reported only once in an HIV-negative individual. We report two cases of hypopyon uveitis in immunocompetent individuals and one case in an immunosuppressed HIV-negative individual. All three subjects were receiving concurrent rifabutin and clarithromycin. Awareness that this entity can occur in HIV negative and nonimmunosuppressed individuals and that it can mimic infectious endophthalmitis may spare the subject from an invasive workup of systemic infection.
Bhagat
N
N
Doheny Eye Institute and the Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033.
Read
R W
RW
Rao
N A
NA
Smith
R E
RE
Chong
L P
LP
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D009877:Endophthalmitis / Q000175:diagnosis; D005128:Eye Diseases / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids; D018023:HIV Seronegativity; D006801:Humans; D007121:Immunocompetence; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D017828:Rifabutin / Q000009:adverse effects*; D013492:Suppuration / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D014606:Uveitis, Anterior / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014792:Visual Acuity; D014822:Vitreous Body / Q000187:drug effects
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D017828:Rifabutin; C009935:prednisolone acetate; D011239:Prednisolone