Jacobs D S, Piliero P J, Kuperwaser M G, Smith J A, Harris S D, Flanigan T P, Goldberg J H, Ives D V
Division of Ophthalmology, Beth Israel Hospital, Boston, MA 02215.
Am J Ophthalmol. 1994 Dec 15;118(6):716-22. doi: 10.1016/s0002-9394(14)72550-4.
We studied patients with a new anterior uveitis syndrome associated with rifabutin use.
Nine patients with the acquired immunodeficiency syndrome (AIDS) who developed acute anterior uveitis were identified retrospectively from institutional ophthalmology, infectious disease, and AIDS primary care practices. Five patients initially had hypopyon; in three patients hypopyon was bilateral and recurrent. The medical history, initial signs and symptoms, diagnostic examination, clinical course, and response to therapy were ascertained by a review of the medical records.
All nine patients were being treated with rifabutin for treatment of, or prophylaxis against, Mycobacterium avium complex. In no patient was another untreated cause of uveitis found. In each patient the uveitis resolved rapidly without sequelae with treatment with topical corticosteroids alone. In eight patients uveitis resolved completely while treatment or prophylaxis for M. avium complex was maintained.
We studied a new hypopyon uveitis syndrome in patients with AIDS who are being treated with rifabutin. The interaction of multiple drugs may contribute to this uveitis syndrome. This uveitis is remarkable because it is fulminant yet responds rapidly to topical corticosteroids. Characterization of this syndrome is important because hypopyon in the immunocompromised patient generally mandates intensive, and sometimes invasive, ophthalmic and systemic examination and therapy. Additional study is required to determine whether immune status, underlying infection, or drug-related factors contribute to the development of this uveitis syndrome. Although this syndrome remains a diagnosis of exclusion, ophthalmologists must be aware of it, so that intervention is guided appropriately.
我们研究了与利福布汀使用相关的一种新型前葡萄膜炎综合征患者。
从机构眼科、传染病科和艾滋病初级保健机构中，回顾性地确定了9例患有后天免疫缺陷综合征（AIDS）并发生急性前葡萄膜炎的患者。5例患者最初有前房积脓；3例患者前房积脓为双侧且复发。通过查阅病历确定病史、初始体征和症状、诊断检查、临床病程及对治疗的反应。
所有9例患者均正在接受利福布汀治疗鸟分枝杆菌复合体或进行预防。未发现任何患者有其他未治疗的葡萄膜炎病因。每位患者仅使用局部皮质类固醇治疗后，葡萄膜炎迅速消退且无后遗症。8例患者在维持鸟分枝杆菌复合体治疗或预防的同时，葡萄膜炎完全消退。
我们研究了正在接受利福布汀治疗的艾滋病患者中的一种新型前房积脓性葡萄膜炎综合征。多种药物的相互作用可能导致了这种葡萄膜炎综合征。这种葡萄膜炎很显著，因为它是暴发性的，但对局部皮质类固醇反应迅速。对该综合征进行特征描述很重要，因为免疫功能低下患者的前房积脓通常需要进行强化的，有时是侵入性的眼科和全身检查及治疗。需要进一步研究以确定免疫状态、潜在感染或药物相关因素是否导致了这种葡萄膜炎综合征的发生。尽管该综合征仍然是一种排除性诊断，但眼科医生必须了解它，以便进行适当的干预。
