Iridocyclitis,
arthralgia, and pseudojaundice have been identified as dose-dependent adverse effects in patients with
acquired immunodeficiency syndrome (
AIDS) who are treated orally with
rifabutin for Mycobacterium avium intracellulare complex (MAC)
infections. Nine episodes of acute
anterior uveitis of varying severity ranging from mild
iridocyclitis to
anterior uveitis with
fibrin or hypopyon, mimicking endogenous metastatic
endophthalmitis, occurred in seven patients. At the time of 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 successively.
Inflammation resolved rapidly on treatment with systemic and topical
antibiotics, on
corticosteroid therapy, and on discontinuation of
rifabutin. In two cases of mild
iridocyclitis, cessation of
rifabutin alone led to resolution of the
uveitis. The combination of
rifabutin,
clarithromycin, and
fluconazole may increase the risk for
anterior uveitis in patients with
AIDS. All of our patients were treated with
fluconazole, with
clarithromycin, or with a combination of both substances in addition to
rifabutin. Identification of
rifabutin-induced
uveitis is important because hypopyon
uveitis in the immunocompromised patient generally evokes intensive and, sometimes, invasive ophthalmic and systemic workup and
therapy. We suggest it to be sufficient for resolution of the inflammatory signs to discontinue
rifabutin medication.