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Acute panuveitis with hypopyon in Crohn's disease secondary to medical therapy: a case report.

Haider D, Dhawahir-Scala FE, Strouthidis NG, Davies N - J Med Case Rep (2007)

Bottom Line: The acute inflammatory episode resolved following treatment with topical corticosteroids and withdrawal of rifabutin.However, use of rifabutin in the management of Crohn's disease is controversial and not widely known to an ophthalmic readership.This report highlights the importance of keeping abreast of novel therapeutic developments in systemic conditions likely to be encountered in ophthalmology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Manchester Royal Eye Hospital, Oxford Road, Manchester, UK. felipe.dhawahir@btinternet.com.

ABSTRACT

Background: A case report to highlight the association between rifabutin and hypopyon

Methods: A 56 year old male presented with a one day history of blurred vision in his right eye. He had an established diagnosis of Crohn's disease which was in remission following treatment with rifabutin and clarithromycin. A brisk anterior uveitis with hypopyon and a mild vitritis was detected in the right eye. The acute inflammatory episode resolved following treatment with topical corticosteroids and withdrawal of rifabutin.

Results: The presence of hypopyon is atypical in uveitis associated with inflammatory bowel disease. The association between rifabutin treatment and hypopyon uveitis is well recognised in Mycobacterium avium paratuberculosis. However, use of rifabutin in the management of Crohn's disease is controversial and not widely known to an ophthalmic readership.

Conclusion: This report highlights the importance of keeping abreast of novel therapeutic developments in systemic conditions likely to be encountered in ophthalmology.

No MeSH data available.


Related in: MedlinePlus

Hypopyon. Anterior segment photograph of right eye showing hypopyon at presentation (Arrow pointing at Hypopyon)
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Figure 1: Hypopyon. Anterior segment photograph of right eye showing hypopyon at presentation (Arrow pointing at Hypopyon)

Mentions: A 56 year old male attended the eye clinic having awoken with blurred vision in his right eye; pain and photophobia were not present. A 15 year history of Crohn's was reported – this was in remission following a year-long trial of 300 mg rifabutin daily with clarithromycin 250 mg daily. Azathioprine had been discontinued by his rheumatologist 2 weeks previously. The patient had never undergone gastro-intestinal surgery, there was no arthritis and no previous history of uveitis. He was HLA-B27 negative. At presentation the best corrected visual acuity was 6/24 OD and 6/6 OS. There was a right anterior uveitis with 4 mm hypopyon (Figure 1). The IOP was 12 mmHg in both eyes. There was moderate vitreous activity in the right eye; no features suggestive of retino-choroidal inflammation or vasculitis were detected and the optic disc was healthy. The left eye was quiet, with no evidence of intra-ocular inflammation. Blood tests including a full blood count, erythrocyte sedimentation rate and C-reactive protein were all within the normal range, in keeping with a state of remission.


Acute panuveitis with hypopyon in Crohn's disease secondary to medical therapy: a case report.

Haider D, Dhawahir-Scala FE, Strouthidis NG, Davies N - J Med Case Rep (2007)

Hypopyon. Anterior segment photograph of right eye showing hypopyon at presentation (Arrow pointing at Hypopyon)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1936424&req=5

Figure 1: Hypopyon. Anterior segment photograph of right eye showing hypopyon at presentation (Arrow pointing at Hypopyon)
Mentions: A 56 year old male attended the eye clinic having awoken with blurred vision in his right eye; pain and photophobia were not present. A 15 year history of Crohn's was reported – this was in remission following a year-long trial of 300 mg rifabutin daily with clarithromycin 250 mg daily. Azathioprine had been discontinued by his rheumatologist 2 weeks previously. The patient had never undergone gastro-intestinal surgery, there was no arthritis and no previous history of uveitis. He was HLA-B27 negative. At presentation the best corrected visual acuity was 6/24 OD and 6/6 OS. There was a right anterior uveitis with 4 mm hypopyon (Figure 1). The IOP was 12 mmHg in both eyes. There was moderate vitreous activity in the right eye; no features suggestive of retino-choroidal inflammation or vasculitis were detected and the optic disc was healthy. The left eye was quiet, with no evidence of intra-ocular inflammation. Blood tests including a full blood count, erythrocyte sedimentation rate and C-reactive protein were all within the normal range, in keeping with a state of remission.

Bottom Line: The acute inflammatory episode resolved following treatment with topical corticosteroids and withdrawal of rifabutin.However, use of rifabutin in the management of Crohn's disease is controversial and not widely known to an ophthalmic readership.This report highlights the importance of keeping abreast of novel therapeutic developments in systemic conditions likely to be encountered in ophthalmology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Manchester Royal Eye Hospital, Oxford Road, Manchester, UK. felipe.dhawahir@btinternet.com.

ABSTRACT

Background: A case report to highlight the association between rifabutin and hypopyon

Methods: A 56 year old male presented with a one day history of blurred vision in his right eye. He had an established diagnosis of Crohn's disease which was in remission following treatment with rifabutin and clarithromycin. A brisk anterior uveitis with hypopyon and a mild vitritis was detected in the right eye. The acute inflammatory episode resolved following treatment with topical corticosteroids and withdrawal of rifabutin.

Results: The presence of hypopyon is atypical in uveitis associated with inflammatory bowel disease. The association between rifabutin treatment and hypopyon uveitis is well recognised in Mycobacterium avium paratuberculosis. However, use of rifabutin in the management of Crohn's disease is controversial and not widely known to an ophthalmic readership.

Conclusion: This report highlights the importance of keeping abreast of novel therapeutic developments in systemic conditions likely to be encountered in ophthalmology.

No MeSH data available.


Related in: MedlinePlus