Levofloxacin-Associated Panuveitis With Chorioretinal Lesions | Ophthalmology | JAMA Ophthalmology | JAMA Network
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Research Letter
Oct 2012

Levofloxacin-Associated Panuveitis With Chorioretinal Lesions

Author Affiliations

Author Affiliations: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Butler); and Casey Eye Institute, Oregon Health and Science University and Portland VA Medical Center, Portland (Dr Suhler).

Arch Ophthalmol. 2012;130(10):1342-1344. doi:10.1001/archophthalmol.2012.2260

Drug-induced uveitis is a rare complication of many commonly prescribed medications, including bisphosphonates, sulfonamides, multiple vaccines, and topical β-blockers.1 Recently, a uveitis-like syndrome with iris transillumination defects and pupillary mydriasis associated with oral moxifloxacin use has been described.2 Fluoroquinolones are an increasingly recognized cause of bilateral uveitis,3 although the visual significance is often minimal. Herein, we describe a visually disabling but reversible manifestation of levofloxacin-associated panuveitis.

In July 2010, a 68-year-old woman without pertinent medical or ocular history visited our uveitis clinic because of decreased vision and floaters bilaterally for 5 days. Two weeks prior, she was bitten by a dog and was prescribed prophylactic levofloxacin. After 4 days of therapy, she noted painless bilateral palmar macules and pustules, followed a day later by blurred vision and floaters in both eyes. She discontinued levofloxacin and was referred to us. Other long-term medications she had been receiving at the time of the initial visit included atenolol, amlodipine besylate, rabeprazole sodium, diphenhydramine hydrochloride, and low-dose aspirin; however, none of these represented a new exposure. Further, the patient was bitten by her own dog whose immunizations were up to date, so rabies vaccination was not necessary.