Methylprednisolone acetate/rifabutin/rituximab
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Posterior corneal deposits: case report A woman in her 30s developed posterior corneal deposits during treatment with rifabutin, rituximab and methylprednisolone acetate. The woman presented for evaluation of corneal opacities. Her medical history was significant for keratoconjunctivitis sicca, Hashimoto thyroiditis and anti-interferon-γ autoantibody syndrome for which she had been receiving rituximab 375 mg/m2 six monthly infusions and methylprednisolone acetate 100mg. She received infusions weekly for the first 3 weeks and then every 6-8 months based on the CD20 count. She also had a history of disseminated Mycobacterium avium complex (MAC) infection, for which she had received rifabutin 300 mg/day, ethambutol [ethambutol hydrochloride] and clarithromycin for 2 years [routes not stated]. This treatment concluded two and half years prior to her current presentation. In addition, she had a history of arthralgias with intermittent arthritis, for which she had received hydroxychloroquine, which had been discontinued 2 years prior presentation. On examination, she had no visual concerns and her visual acuity was noted to be 20/20 for both eyes. Slit-lamp examination revealed multiple bilateral, peripheral light brown corneal opacities. The opacities were present circumferentially and were located in the far posterior corneae. Anterior segment optical coherence tomographic findings revealed focal areas of hyper-reflectivity anterior to the Descemet membrane. Confocal microscopy demonstrated hyper-reflective, variably shaped clusters of opacities anterior to the endothelium. A diagnosis of rifabutin-related posterior corneal deposits was made. Nineteen months after drug initiation, the deposits were first noted in the inferior corneas only. During the 2-year course of rifabutin, they progressed circumferentially to involve the complete peripheral cornea, suggestive of cumulative dose or time-dependent risk for the development and density of corneal deposits with rifabutin therapy. However, the lesions persisted after discontinuation of rifabutin therapy. Also, rituximab and methylprednisolone acetate were though to have contributed to the occurrence of corneal deposits [not all times to reaction onset stated]. Ahmad TR, et al. Corneal Deposits in a Patient With Anti-Interferon-gamma Autoantibody Syndrome. JAMA Ophthalmology 138: 310-311, No. 3, 9 Jan 2020. Available 803520191 from: URL: http://doi.org/10.1001/jamaophthalmol.2019.4925
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Reactions 12 Dec 2020 No. 1834
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