Uveitis associated with rifabutin therapy.
OBJECTIVE
To highlight the association of uveitis with the use of rifabutin.


METHODS
Retrospective study of two patients with acute anterior uveitis.


RESULTS
Both patients were receiving rifabutin for treatment of atypical Mycobacterium infection associated with AIDS when they developed unilateral acute anterior uveitis and arthritis. The inflammation resolved and vision improved with introduction of topical corticosteroids, mydriatics and cessation of rifabutin treatment.


CONCLUSIONS
Use of rifabutin with clarithromycin may precipitate acute uveitis in patients with AIDS being treated for systemic Mycobacterium avium complex infection. Uveitis produced by rifabutin may be analogous to Herxeimer reaction as seen in syphilis. Clarithromycin and fluconazole elevate levels of rifabutin due to inhibition of metabolism through cytochrome p-450 pathway. The differential diagnosis includes Reiter's syndrome, syphilis causing uveitis, metastatic endophthalmitis, and direct HIV-related uveitis.
Gioulekas
J
J
Royal Melbourne Hospital, Grattan Street, Parkville 3050, Victoria.
Hall
A
A
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000009:adverse effects*; D001168:Arthritis / Q000139:chemically induced / Q000188:drug therapy; D001285:Atropine / Q000627:therapeutic use; D017291:Clarithromycin / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy; D012189:Retrospective Studies; D017828:Rifabutin / Q000009:adverse effects*; D014606:Uveitis, Anterior / Q000139:chemically induced* / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000904:Antibiotics, Antitubercular; D005938:Glucocorticoids; D017828:Rifabutin; D001285:Atropine; D017291:Clarithromycin