Toomey Christopher B, Lee Jeffrey, Spencer Doran B
Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Case Rep Ophthalmol. 2020 Apr 22;11(1):156-160. doi: 10.1159/000506181. eCollection 2020 Jan-Apr.
We report a novel case of severe bilateral panuveitis with hypopyon secondary to rifabutin and cobicistat drug interaction in the setting of human immunodeficiency virus (HIV) infection and latent tuberculosis (TB). A 63-year-old woman presented with bilateral conjunctival injection and decreasing vision of 5 days' duration. She had a history of well-controlled HIV infection, latent TB, and non-alcoholic steatohepatitis for which she was inadvertently being treated, due to a pharmacy error, concurrently with the anti-TB medicine rifabutin and the highly active antiretroviral therapy combination Genvoya® (elvitegravir 150 mg - cobicistat 150 mg - emtricitabine 200 mg - tenofovir alafenamide 10 mg). Ocular examination was significant for bilateral panuveitis with hypopyon. Blood, cerebrospinal fluid, and vitreous analysis were negative for infectious or rheumatologic abnormalities. Rifabutin was discontinued and the patient was treated with intravenous followed by oral steroids as an outpatient with eventual resolution of symptoms. This unique case of rifabutin-cobicistat drug interaction highlights the association between rifabutin drug levels and ocular inflammation and expands the potential presentation of rifabutin-associated uveitis to include bilateral panuveitis with hypopyon.
我们报告了一例在人类免疫缺陷病毒（HIV）感染和潜伏性结核病（TB）背景下，因利福布汀与考比司他药物相互作用继发严重双侧全葡萄膜炎伴前房积脓的新病例。一名63岁女性因双眼结膜充血和视力下降5天就诊。她有HIV感染控制良好、潜伏性TB和非酒精性脂肪性肝炎病史，由于药房失误，她在无意中同时接受抗结核药物利福布汀和高效抗逆转录病毒治疗组合Genvoya®（埃替格韦150毫克 - 考比司他150毫克 - 恩曲他滨200毫克 - 替诺福韦艾拉酚胺10毫克）治疗。眼部检查显示双侧全葡萄膜炎伴前房积脓。血液、脑脊液和玻璃体分析未发现感染或风湿性异常。停用利福布汀，患者作为门诊患者接受静脉注射，随后口服类固醇治疗，症状最终缓解。这例独特的利福布汀 - 考比司他药物相互作用病例突出了利福布汀药物水平与眼部炎症之间的关联，并扩大了利福布汀相关葡萄膜炎的潜在表现，包括双侧全葡萄膜炎伴前房积脓。
