Iritis associated with intravenous cidofovir

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
• Intravenous cidofovir is an effective antiviral agent for managing CMV retinitis.
• Previous treatments for CMV retinitis include ganciclovir and foscarnet.

Observation:

• Two patients with AIDS and CMV retinitis developed iritis after receiving intravenous cidofovir.
• Iritis symptoms emerged after the second or third dose of cidofovir, presenting unilaterally in one patient and bilaterally in the other.
• The iritis resolved with topical ophthalmic treatment but recurred upon subsequent cidofovir infusions.

Findings:

• Intravenous cidofovir, particularly when co-administered with oral probenecid, can uncommonly lead to iritis.
• Discontinuation of cidofovir and prompt administration of topical corticosteroids and mydriatic agents typically result in reversible iritis.
• One patient experienced post-inflammatory fixed dilated pupils.

Implications:

• Clinicians should be vigilant for iritis as a potential adverse effect of intravenous cidofovir in AIDS patients with CMV retinitis.
• Early recognition and management, including drug cessation and appropriate ophthalmic therapy, are crucial for favorable outcomes.
• This case series highlights the importance of monitoring for ocular inflammation during cidofovir treatment.