Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin
B. R. Saran, A. M. Maguire, C. Nichols, I. Frank, R. W. Hertle, A. J. Brucker, S. Goldman, M. Brown and B. Van Uitert
Department of Ophthalmology, Scheie Eye Institute, Philadelphia.
OBJECTIVE: Iridocyclitis has been identified as a dosage-dependent side
effect in patients with the acquired immunodeficiency syndrome (AIDS) who
are treated for Mycobacterium avium complex (MAC) infection with systemic
rifabutin. We reviewed cases of acute hypopyon uveitis occurring in
patients with AIDS to establish whether there was an association. DESIGN:
Retrospective case series. SETTING: Outpatient clinic and inpatient
hospital-based ophthalmology referral practice and infectious disease
specialty service. PATIENTS: Seven patients with AIDS, aged 10 to 40 years,
presenting with acute unilateral hypopyon mimicking infectious
endophthalmitis. MAIN OUTCOME MEASURES: Findings from complete
ophthalmological evaluation and ancillary laboratory testing. RESULTS: At
the time of presentation, all seven patients were receiving treatment for
MAC infection with rifabutin (dosage range, 300 to 600 mg/d) and
clarithromycin. Results of microbiological investigations in five patients
were negative. Iridocyclitis became bilateral in all seven patients, and
hypopyon developed in the contralateral eye in five of seven patients.
Hypopyon resolved rapidly with intensive topical corticosteroid therapy.
Residual inflammation responded to topical corticosteroids with or without
reduction of the rifabutin dosage. CONCLUSIONS: Concomitant use of
rifabutin, clarithromycin, and fluconazole may precipitate hypopyon uveitis
in patients with AIDS being treated for MAC infection.
