Rifabutin-associated hypopyon uveitis and retinal vasculitis with a history of acute myeloid leukemia

Abstract

PurposeThis study reports a case of bilateral rifabutin-associated uveitis in a child with a history of acute myeloid leukemia.MethodsWe utilized a clinical case description and brief discussion.ResultsA 17-year-old girl presented with acute bilateral anterior uveitis, a hypopyon in the left eye, and moderate bilateral vitritis. She had a history of acute myeloid leukemia status post-allogeneic hematopoietic stem cell transplant 5 years earlier. She was receiving rifabutin for a biopsy-proven Mycobacterium avium complex pulmonary infection. Work up for infectious and neoplastic etiologies was negative. The uveitis initially responded to topical corticosteroids, but recurred when the drops were tapered. Fluorescein angiography demonstrated diffuse vasculitis of small retinal vessels and cystoid macular edema. After rifabutin was discontinued, the uveitis and vasculitis slowly resolved.ConclusionFluorescein angiography demonstrated widespread retinal vasculitis which is a rare manifestation of rifabutin-associated uveitis.

Drug-induced uveitis

“…It is most commonly associated with anterior uveitis with hypopyon (Figure 1), although intermediate uveitis, panuveitis, and retinal vasculitis have been reported [18,19]. …”

“…The inflammation completely resolved following cessation of rifabutin. Photograph courtesy of H. Nida Sen, MD, MHS (see [18]).…”

Bilateral Hypopyon in a Young Woman

“…1 Noninfectious causes include uveitis, most commonly HLA B-27-associated or Behçet disease-associated inflammation, and postsurgical or medical-induced inflammation, such as with rifabutin. 5 Infectious causes can be exogenous with postsurgical or traumatic inoculation or endogenous, such as endogenous endophthalmitis from hematological spread. Hypopyon due to neoplasia can be caused by leukemia, lymphoma, reti-noblastoma, melanoma, or metastases.…”

“…The differential diagnosis for hypopyon includes 4 broad categories: noninfectious inflammation, infectious, neoplastic, and corneal etiologies . Noninfectious causes include uveitis, most commonly HLA B-27–associated or Behçet disease–associated inflammation, and postsurgical or medical-induced inflammation, such as with rifabutin . Infectious causes can be exogenous with postsurgical or traumatic inoculation or endogenous, such as endogenous endophthalmitis from hematological spread.…”

Bilateral uveitis associated with concurrent administration of rifabutin and nelfinavir

“… 4 The most frequent type is unilateral anterior uveitis with concomitant mild vitritis, but bilateral cases, intermediate uveitis, panuveitis, or even dense vitritis mimicking infectious endophthalmitis or panophthalmitis have also been reported. 4 5 6 However, it often resolved within 1–2 months after drug discontinuation and the use of intensive topical corticosteroids and cycloplegics. 4 7 8 …”