rifabutin induced uveitis

1995 May;206(5):388-90. doi: 10.1055/s-2008-1035471. Uveitis may occur weeks to months after initial exposure to the drug if this mechanism is at work. Discontinuation or decreasing the dose of rifabutin to 300 mg/day and treatment with topical steroids and cycloplegics resulted in resolution of the uveitis within two weeks. 2008 Sep-Oct;56(5):363-75. doi: 10.4103/0301-4738.42412. Most of our understanding of rifabutin-induced uveitis comes from cases series reported in the early- to mid-1990s [20-23]. Among the screened patients, a total of 221 (8%) patients who received rifabutin replacing rifampicin were included. The rifabutin was stopped two months after the initiation and the uveitis resolved with topical corticosteroids. ... Drug-induced: e.g. matory opacities of the vitreous in rifabutin-associated uveitis. The uveitis onset varies from 1.5 to 11.5 months after commencing rifabutin therapy [26,30]. Please enable it to take advantage of the complete set of features! Conclusion: Rifabutin rarely causes uveitis as an ocular side effect. Rifabutin-induced uveitis occurs rarely when the drug is used as sole antimycobacterial therapy at the usual prophylactic dosage (i.e., 300 mg daily) for the prevention of M. avium complex (MAC) infections in patients with advanced HIV infection, even in combination with macrolide antibiotics or … HHS 1 33 Permanent discontinuance may be necessary if uveitis is severe. Curr Opin Ophthalmol, 29(6):588-603, 01 Nov 2018 Cited by 3 articles | PMID: 30222658. Review. Data synthesis: For example, the patient database at the tertiary referral Uveitis Clinic at the Casey Eye Institute, Oregon Health Sciences University records an incidence of less than 0.5%. rifabutin, sulfonamides, bisphosphonates, fluoroquinolones (FQs), intravitreal anti-vascular endothelial growth factor (VEGF), and topical antiglaucoma med-ications (brimonidine and prostaglandin [PG] analogues). Drug-induced uveitis is a relatively rare occurrence. In all reported cases, patients were receiving concurrent therapy with clarithromycin and/or fluconazole, both of which have inhibitory effects on rifabutin metabolism. Rifabutin-induced uveitis occurs rarely when the drug is used as sole antimycobacterial therapy at the usual prophylactic dosage (i.e., 300 mg daily) for the prevention of M. avium complex (MAC) infections in patients with advanced HIV infection, even in combination with macrolide antibiotics or … Clipboard, Search History, and several other advanced features are temporarily unavailable. 2006;3(1):103-10. doi: 10.1513/pats.200511-119JH. Both patients received the regimen of clarithromycin and rifabutin to treat MAC infection. Systemic sulfonamides, rifabutin, and topical glucocorticoids fulfill at least five criteria.  |  Uveitis is a rare, dose-related toxicity of this therapy. The purpose of this study is to report the case of an HIV+ patient with unilateral rifabutin induced intermediate uveitis after 4 months of treatment with low dose rifabutin (150 mg daily) in combination with ritonavir and fluconazole. USA.gov. Intermediate uveitis is a relatively rare manifestation of Rifabutin induced uveitis. 1 33 In mild cases, rifabutin can be reinstituted; if signs and symptoms of uveitis recur, discontinue immediately. Intermediate uveitis, panuveitis and retinal vasculitis have been reported with rifabutin. So the hypopyon anterior uveitis, often unilateral, was a characteristic finding of rifabutin induced uveitis. Rifabutin is used to treat and prevent disseminated Mycobacterium avium-complex infection. OBJECTIVE: Uveitis has been increasingly recognised as a side effect of rifabutin regimens in the prophylaxis and treatment of Mycobacterium avium intracellulare (MAI) infection. COVID-19 is an emerging, rapidly evolving situation. The authors review reports of drug-associated uveitis, applying the seven criteria and examining possible mechanisms. Uveitis Associated with Rifabutin Therapy . Anterior uveitis has been reported in 26-52% of patients with CMV retinitis after intravenous treatment after a median of 4-11 doses of intravenous cidofovir . Rifabutin-induced uveitis with inflammatory vitreous infiltrate. More recent reports noting the association of uveitis with these lower dosages of rifabutin have raised concerns about the prevalence of this adverse event. Advances in the diagnosis and treatment of tuberculosis. It’s a derivative of rifampin, used in immunocompromised patients, and it was characterized by hypopyon development. Risk factors for developing rifabutin associated-uveitis include a high dose of rifabutin reaching 600 mg orally daily, low body weight, and concomitant use of other drugs, such as macrolides or ritonavir. Of these patients, 158 (72%) tolerated rifabutin during treatment, but 47 (21%) and 16 (7%) experienced mild and severe rifabutin-related ARs (including neutropenia, severe hepatitis and uveitis), respectively, and needed to discontinue rifabutin. Proc Am Thorac Soc. Mycobacterium avium complex infection, rifabutin, and uveitis--is there a connection? In some cases, hy-popyon and severe vitritis with snowballs opac-ities can be present (16). Because this toxicity appeared to be dose-related, lower dosages (300-600 mg/d) of rifabutin were selected for study in subsequent clinical trials. monly associated with anterior uveitis with hypopyon (Figure 1), although intermediate uveitis, panuveitis, and retinal vasculitis have been reported [18,19]. All articles and abstracts reporting uveitis potentially related to rifabutin were considered for inclusion. NLM Rifabutin-associated anterior uveitis in patients infected with human immunodeficiency virus. NIH The eye looked relatively quiet. Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. No data. Patients receiving therapy with combinations of any of these agents should be warned about signs and symptoms of uveitis and be monitored closely for the development of rifabutin toxicity. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Conclusions: 4,5,9 Clarithromycin is a member of the macrolide group of antibiotics, which inhibits cytochrome P450 (CYP450). Rarely, pan-uveitis with retinal vasculitis has been reported [26,29]. Drug-induced uveitis is a relatively rare occurrence. Arevalo JF, Russack V, Freeman WR (1997) New ophthalmic manifestations of presumed rifabutin-related uveitis. Drug induced uveitis Margherita Meniconi, M.D. Int Ophthalmol. 1996 Apr;22 Suppl 1:S43-7; discussion S47-9. Such uveitis is termed ‘idiopathic’, although there is good evidence for it having an autoimmune/autoinflammatory aetiology.20 21 In a small proportion, some other precipitant is identified: trauma (including ocular surgery) or, rarely, lens induced or drugs (eg, cidofovir or rifabutin).13 22 23 The purpose of this study is to report the case of an HIV+ patient with unilateral rifabutin induced intermediate uveitis after 4 months of treatment with low dose rifabutin (150 mg daily) in combination with ritonavir and fluconazole. Bisphosphonates • Topical Drugs 1. 27 In some cases, hy-popyon and severe vitritis with snowballs opac-ities can be present (16). Drug Induced Uveitis • Systemic Drugs 1. Saran and associates described the clinical features of seven patients with HIV/AIDS who received between 300 to 600 mg of rifabutin daily … Shafran SD, Singer J, Zarowny DP, Phillips P, Salit I, Walmsley SL, Fong IW, Gill MJ, Rachlis AR, Lalonde RG, Fanning MM, Tsoukas CM. We will report a case of uveitis induced by the same substance in a patient treated for hypercalcemia secondary to multiple myeloma. Diethylcarbamazine • Intracameral Drugs 1. Uveitis is usually due to immune or infectious causes; however, certain systemic or local drugs may also precipitate intra­ocular inflammation. Only systemically administered biphosphonates and, perhaps, topical metipranolol meet all seven criteria. However, clarithromycin and/or fluconazole can raise rifabutin levels (and consequently the risk for uveitis) due to shared hepatic metabolism by the same cytochrome P450 system. Note the typical history and important findings of a constricted slightly irregular pupil with ciliary flush (i.e. Early diagnosis and is important and reduction or discontinuance of the rifabutin as well as anti-inflammatory therapy need to be implemented when a patient develops this condition. Introduction Disodium Pamidronate, a Calcium regulating agent, was described by Macarol and Frauenfelder [1] and other authors [2-5] to induce ocular inflammation. HIV: primary and secondary prophylaxis for opportunistic infections. Clin Infect Dis. Rifabutin is a member of the rifamycin family of drugs, and is used to treat MAC, tuberculosis, and atypical mycobacteriosis. Fifty-four cases were identified. Intermediate uveitis is a relatively rare manifestation of Rifabutin induced uveitis.  |  Rifabutin-induced anterior uveitis has been reported previously. Rifabutin is prescribed frequently for the prophylaxis and treatment of MAC infection, especially in patients with HIV. The first through deposits accompanying drug-induced uveitis … Topical ocular medications such as beta-blockers and corticosteroids as well as other topical ocular medications have been associated with uveitis. Rifabutin associated uveitis has been described in AIDS patients and is identified as a dose-dependent, idiosyncratic side effect [7]. Sudharshan S, Nair N, Curi A, Banker A, Kempen JH. N Engl J Med.  |  To describe an ocular complication of rifabutin therapy in the treatment of Mycobacterium avium complex (MAC) infection in the absence of HIV infection or AIDS. '5 This drug interaction may explain the significantly Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. severe acute anterior uveitis, spillover vitreous cells may occur. Drug-Induced Uveitis Kara C. LaMattina Nehali V. Saraiya Debra A. Goldstein Uveitis is usually a result of immune or infectious causes; however, certain systemic or local drugs may also precipitate intraocular inflammation. Apropos of 3 patients]. Direct mechanisms are thought to play a role with topically or intracamerally instilled drugs… Schimkat M, Althaus C, Becker K, Sundmacher R. Kelleher P, Helbert M, Sweeney J, Anderson J, Parkin J, Pinching A. Genitourin Med. USA.gov. SETTING: Tertiary care institution, The Royal Hospitals … We will report a case of uveitis induced by the same substance in a patient treated for hypercalcemia secondary to multiple myeloma. The purpose of this study is to report the case of an HIV+ patient with unilateral rifabutin induced intermediate uveitis after 4 months of treatment with low dose rifabutin (150 mg daily) in combination with ritonavir and fluconazole. Clin Infect Dis. Schimkat M, Althaus C, Becker K, Sundmacher R. Chevalley GF, Kaiser L, Bouchenaki N, Baglivo E, Kress O. Klin Monbl Augenheilkd. NIH Study selection and data extraction: 1996 Apr;22 Suppl 1:S23-30; discussion S30-2. 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