艾滋病患者药物性葡萄膜炎2例报告。

M Bazewicz, J Fikri, C H Martin, A Libois, A Meunier, F Frippiat, L Caspers, F Willermain
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摘要

获得性免疫缺陷综合征(AIDS)患者可发展为严重的葡萄膜炎。虽然感染性和自身免疫性原因必须考虑,药物性葡萄膜炎也是一个重要的病因。在此,我们提出两个病例报告,说明利法布汀和西多福韦诱发葡萄膜炎的经典表现。第一个病例是一名33岁的艾滋病妇女,接受抗蛋白酶和抗结核药物(包括利福布汀)治疗。她右眼红肿痛。有强烈的前段炎症伴纤维性渗出和密集的玻璃体炎。停用利福布汀,给予局部类固醇和抗炎药。眼内炎症和症状迅速消失。第二例患者是一名36岁的女性,她表现为左眼视力疼痛下降。她在艾滋病背景下接受了双侧巨细胞病毒性视网膜炎的随访,最近接受了2次全身注射西多福韦。可见双眼前段炎症伴后粘连,左眼后粘连膜皱褶。左眼眼压0 mmHg,右眼眼压10 mmHg。眼底检查发现右眼CMV视网膜炎瘢痕,左眼黄斑可见脉络膜褶皱。停用西多福韦,开始使用局部类固醇和阿司匹林。炎症逐渐减轻,眼压恢复到正常水平。总之,利法布汀和西多福韦是药物性葡萄膜炎的典型例子,具有明显的临床特征。在艾滋病患者身上认识到这些实体,可以避免对这些脆弱的人进行无用和潜在的侵入性干预。
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Drug-induced uveitis in aids patients: two case reports.

Patients with acquired immunodeficiency syndrome (AIDS) can develop severe uveitis. Although infectious and autoimmune causes must always be considered, drug induced uveitis is also an important etiology. Herein, we present two case reports illustrating the classical presentation of rifabutin and cidofovir induced uveitis. The first case was a 33 year old woman with AIDS treated with anti-protease and anti-tuberculosis drugs (including rifabutin). She presented with a red painful right eye. There was a strong anterior segment inflammation with fibrinous exudates and a dense vitritis. Rifabutin was stopped and topical steroids and mydriatics were given. Intraocular inflammation and symptoms rapidly resolved. The second patient was a 36 year old woman who presented with a painful decrease of vision in her left eye. She was followed for bilateral CMV retinitis in the setting of AIDS and had recently received 2 systemic injections of cidofovir. Anterior segment inflammation with posterior synechiae in both eyes and folds of Descemet membrane in the left eye were noted. Intraocular pressure was 0 mmHg in the left eye and 10 mmHg in the right eye. Fundus examination disclosed CMV retinitis scars in the right eye and choroidal folds in the macula of the left eye. Cidofovir was discontinued and topical steroids and mydriatics started. Progressively the inflammation decreased and the intraocular pressure returned to normal levels. In conclusion, rifabutin and cidofovir are classical examples of drug induced uveitis with distinct characteristic clinical presentation. Recognition of those entities in AIDS patients can avoid useless and potentially invasive interventions in those fragile people.

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