Mycobacterium avium complex infection, rifabutin, and uveitis--is there a connection?

Rifabutin, an antimycobacterial agent, has been recommended by the U.S. Public Health Service as prophylaxis against infection due to Mycobacterium avium complex (MAC) in patients with AIDS. When rifabutin is administered as prophylaxis, uveitis has been reported only rarely. However, uveitis has been reported in two studies in which rifabutin was administered at higher doses in combination with an azole, a macrolide, or both for treatment of disseminated MAC infection. The uveitis that has been reported has been predominantly anterior and mild-to-moderate in nature, although severe hypopyon uveitis has occasionally been reported. No etiologic infectious agent has been isolated from any of these patients, and treatment with topical steroids and cycloplegics usually leads to rapid resolution of the uveitis. It is necessary to discontinue prophylaxis or therapy with rifabutin only in cases of uveitis that are refractory to treatment or when the uveitis recurs. Immunologic factors, rather than direct drug toxicity, appear to be the most likely explanation for the occurrence of uveitis in patients receiving rifabutin; however, further study is required to elucidate the mechanisms involved.