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Abstract
Purpose
To describe a case of symptomatic rifabutin-related uveitis with hypopyon and vitreous opacity in apatient with acquired immunodeficiency syndrome infected with Mycobacterium tuberculosis.
Case summary
A 33-year-old male patient with acquired immunodeficiency syndrome was referred to our clinic for abruptly decreased vision in his right eye. Multi-drug therapy with rifabutin was administered for 5 weeks to treat tuberculosis enteritis and pulmonary tuberculosis. Visual acuity of the right eye was hand motion and hypopyon as well as vitreous opacity was found in ocular examinations. Other serologic tests, anterior chamber paracentesis and lumbar puncture test were normal. Rifabutin was immediately stopped and topical steroid and cycloplegics were administered, which resulted in resolution of the hypopyon, vitreous opacity and visual acuity. Four weeks after the initial episode, rifabutin was restarted to treat the pulmonary tuberculosis and rifabutin-related uveitis relapsed in the opposite eye.
References
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Figure 1.
(A) Anterior segment photography shows hypopyon (1 mm in height) and fibrinoid reaction in the anterior chamber (AC). The grade of cells in AC was 4+. (B) The B-scan ultrasonogram shows abnormal spikes in vitreous (yellow arrows). (C) Fundus photography shows dimly seen the posterior pole due to vitreous opacity. There was no evidence of retinitis or retinal vasculitis.
Figure 2.
(A) After a week of topical steroid and cycloplegic treatment, anterior chamber (AC) inflammation nearly disappeared. The grade of AC cell was trace. The lens was clear. (B) There is no evidence of retinitis or retinal vasculitis. (C) There was no evidence of macular edema and epiretinal membrane on optical coherence tomography. Visual acuity increased to 0.7.
Figure 3.
After 4 weeks of the initial episode, rifabutin was resumed. One month later, the patient complained of decreased visual acuity in his left eye. (A) Slit lamp examination showed hypopyon (1 mm in height) in the anterior chamber (AC) and the grade of AC cell was 4+ in the left eye. Right eye was normal. (B) Rifabutin was stopped and topical steroid and cycloplegic treatment was started in his left eye. One week after treatment, hypopyon disappeared and anterior chamber cell decreased. The grade of AC cell was 3+. (C) No retinal detachment was noted on B-scan ultrasonogram. (D) The optical coherence tomography showed no evidence of macular edema and epiretinal membrane.
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