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Ophthalmology · Uvea: rifabutin uveitis
Sample itemA man with advanced HIV is on rifabutin and clarithromycin for Mycobacterium avium complex prophylaxis. He develops a painful red eye with hypopyon. Which is the most likely explanation?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Drug-induced uveitis from raised rifabutin levels
Rifabutin can cause anterior uveitis with hypopyon, and clarithromycin raises its blood levels. It resolves on stopping or reducing the drug and treating with topical steroids. The temporal link with a drug interaction makes this the most probable cause.
Option by option
A. HLA-B27 anterior uveitis
HLA-B27 uveitis needs a spondyloarthropathy background and does not fit the timing.
B. Drug-induced uveitis from raised rifabutin levels (correct)
Correct. Rifabutin with clarithromycin raises levels and gives uveitis with hypopyon.
C. Behcet disease
Behcet disease features oral ulcers and a painless hypopyon, and is not drug related.
D. Cytomegalovirus retinitis
CMV causes painless retinitis with little anterior inflammation.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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