Uveitis associated with rifabutin therapy

Purpose: 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. Conclusion: 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.