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Iritis associated with intravenous cidofovir.
A L Tseng1, C B Mortimer, I E Salit
1The Toronto Hospital, Faculty of Pharmacy, University of Toronto, Ontario, Canada. atseng@torhosp.toronto.on.ca
The Annals of Pharmacotherapy
|March 20, 1999
Summary
Intravenous cidofovir can cause iritis in patients with AIDS and cytomegalovirus retinitis. Symptoms resolved upon discontinuation of cidofovir and treatment with corticosteroids.
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.