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Rifampicin-Associated DRESS Syndrome Followed by Rifabutin-Associated Hypopyon Uveitis in an Immunocompetent Patient
Murat Oklar1, Faruk Muharrem Öztürk1, Nilüfer Zorlutuna Kaymak1
1Department of Ophthalmology, University of Health Sciences, Kartal Dr Lutfi Kirdar City Hospital, Istanbul, Türkiye.
Ocular Immunology and Inflammation
|June 13, 2026
Summary
This case study details a patient experiencing severe hypersensitivity reactions to two rifamycin drugs. First, rifampicin caused drug reaction with eosinophilia and systemic symptoms (DRESS), followed by rifabutin-induced hypopyon uveitis.
Area of Science:
- Pharmacology
- Ophthalmology
- Infectious Diseases
Background:
- Hypersensitivity reactions to antibiotics can be severe and life-threatening.
- Rifamycin derivatives are crucial in treating mycobacterial infections.
- Sequential reactions to related drugs highlight potential class-specific toxicities.
Purpose of the Study:
- To report a unique case of sequential hypersensitivity reactions to two rifamycin agents.
- To describe drug reaction with eosinophilia and systemic symptoms (DRESS) following rifampicin.
- To document hypopyon uveitis occurring after rifabutin administration in the same patient.
Main Methods:
- Single-patient retrospective case description.
- Clinical, laboratory, and ophthalmological evaluations.
- Systemic workup including HLA-B27 typing.
Main Results:
- An immunocompetent woman developed probable DRESS after rifampicin for Mycobacterium kansasii infection.
- Following treatment modification and subsequent rifabutin use, she experienced bilateral sequential hypopyon uveitis.
- Both reactions resolved after discontinuation of the offending drug and appropriate treatment.
Conclusions:
- This case illustrates sequential severe hypersensitivity to rifampicin (DRESS) and rifabutin (hypopyon uveitis).
- A potential shared class susceptibility to rifamycins is suggested.
- Vigilance and careful drug histories are essential when switching between rifamycin agents.
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