Rifabutin and Uveitis

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Abstract
We report two cases of uveitis associated with rifabutin therapy. A 52-year-old woman with pulmonary Mycobacterium avium complex infection who was negative for the human immunodeficiency virus was referred to our clinic in October 1992 after being treated with several antimicrobial regimens without improvement. With a regimen of clarithromycin, ethambutol, and rifampin, fever and night sweats resolved and cough and dyspnea improved greatly. In May 1993 the patient's respiratory symptoms worsened, and on June 10, 1993, rifampin was discontinued and treatment with rifabutin at a daily dose of 600 mg was initiated. Because of low-grade fever, ciprofloxacin was added to the regimen on July 2 but was stopped six days later because of the development of oral ulcers. The oral ulcers resolved, but on July 17 the patient noted a pruritic, erythematous rash on her upper extremities and blurred vision and pain in her right eye. By July 22, the left eye was also involved, and an ophthalmologic examination revealed bilateral anterior uveitis. The patient denied having arthralgias or genitourinary symptoms, but said she had had a similar rash in 1989 during treatment with a regimen that included rifabutin. A rapid plasma reagin test was nonreactive, and a chest film showed no changes. Rifabutin was discontinued, and the uveitis was treated with topical prednisone and scopolamine. The uveitis resolved within a couple of weeks and had not recurred after four months.