Journal of the Chinese Medical Association
Volume 70, Issue 3 , Pages 136-139, March 2007

Rifabutin-induced Hypopyon Uveitis in Patients with Acquired Immunodeficiency Syndrome Infected with Mycobacterium avium Complex

  • Hsin-Hui Wang

      Affiliations

    • Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Yu-Mei Chung

      Affiliations

    • Uveitis Service, Department of Ophthalmology, National Yang-Ming University and Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Yu-Mei Chung, Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Ying-Cheng Lin

      Affiliations

    • Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Hsing-Chuan Hu

      Affiliations

    • Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Wing-Wai Wong

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, R.O.C.

Received 18 May 2006; accepted 22 January 2007.

Article Outline

Rifabutin is a semi-synthetic antimycobacterial agent mainly used in the prophylaxis and treatment of Mycobacterium avium complex (MAC) in acquired immunodeficiency syndrome patients. Uveitis as a side effect of rifabutin has been recognized and established since 1994, but there was no case previously described in Taiwan so far. We report 2 cases of rifabutin-induced hypopyon uveitis in patients with human immunodeficiency virus and MAC infection. Both patients received the regimen of clarithromycin and rifabutin to treat MAC infection. Uveitis resolved after discontinuing of rifabutin and treatment with topical corticosteroid and mydriatics. Early recognition of this entity can prevent invasive ocular procedures and treatments. Doctors who prescribe rifabutin should be aware of this ocular complication of uveitis and drug-drug interactions. Ophthalmologists should put this on the list of differential diagnoses for uveitis.

Key Words:  HIV , hypopyon , Mycobacterium avium complex , rifabutin , uveitis

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. CDC  . Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus . MMWR . 1993;42(RR-9):14–20
  2. Nightingale SD, Cameron DW, Gordin FM, Sullam PM, Cohn DL, Chaisson RE, et al  Two controlled trials of rifabutin prophylaxis against Mycobacterium avium complex infection in AIDS . N Engl J Med . 1993;329:828–833
  3. Shafran SD , Deschenes J , Miller M , Philips P , Toma E . The MAC study Group of the Canadian HIV Trial Network: uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin and ethambutol . N Engl J Med . 1994;330:438–439
  4. Jacobs DS, Piliero PJ, Kuperwaser MG, Smith JA, Harris SD, Flanigan TP, et al  Acute uveitis associated with rifabutin used in patients with human immunodeficiency virus infection . Am J Opthalmol . 1994;118:717–722
  5. Saran BR, Maguire AM, Nichols C, Frank I, Hertle RW, Brucker AJ, et al  Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin . Arch Ophthalmol . 1994;112:1159–1165
  6. Havlir D , Torriani F , Dube M . Uveitis associated with rifabutin prophylaxis . Ann Intern Med . 1994;121:510–512
  7. Mwanza JC , Kayembe DL . Uveitis in HIV-infected patients . Eur J Ophthalmol . 2001;11:53–56
  8. Shafran SD, Singer J, Zarowny DP, Deschenes J, Phillips P, Turgeon F, et al  Determinants of rifabutin-associated uveitis in patients treated with rifabutin, clarithromycin, and ethambutol for Mycobacterium avium complex bacteria: a mul-tivariate analysis. Canadian HIV Trial Network Protocol Study Group . J Infect Dis . 1998;177:252–255
  9. Kelleher P , Helbert M , Sweeney J , Anderson J , Parkin J , Pinching A . Uveitis associated with rifabutin and macrolide therapy for Mycobacterium avium intracellulae infection in AIDS patients . Genitourin Med . 1996;72:419–442
  10. DATRI 001 Study Group  . Coadministration of clarithromycin alters the concentration-time profile of rifabutin. 34th Inter-science Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology; 1994; Abstract A2.
  11. CDC  . Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations . MMWR . 1998;47(RR-20):1–51
  12. CDC  . Notice to readers: updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors . MMWR . 2000;49(RR-9):185–189
  13. Whitcup SM, Fortin E, Lindblad AS, Griffiths P, Metcalf JA, Robinson MR, et al  Discontinuation of anti-cytomegalovirus therapy in patients with HIV infection and cytomegalovirus retinitis . JAMA . 1999;282:1633–1637

PII: S1726-4901(09)70345-4

doi:10.1016/S1726-4901(09)70345-4

Journal of the Chinese Medical Association
Volume 70, Issue 3 , Pages 136-139, March 2007

Article Tools