Visually significant corneal deposits associated with rifabutin therapy for Bartonella henselae

To report the clinical and histopathological features of a case of visually significant corneal deposits due to rifabutin therapy used to treat Bartonella henselae . A 73-year-old male with a history of recurrent bartonellosis on rifabutin therapy presented with glare and haloes in both eyes. Slit lamp examination showed pigmented corneal deposits, higher in density and larger in size in the periphery than the center. Rifabutin was discontinued, but the corneal deposits and visual symptoms persisted more than one year later. The patient underwent a penetrating keratoplasty of the left eye. Histopathologic evaluation of the cornea revealed focal tan-golden round/granular-like deposits in the deep corneal stroma and in rare endothelial cells. There was no evidence of inflammation. This case illustrates the histopathologic features of rifabutin-induced corneal deposits, providing novel insights about the pathophysiology of these deposits. Clinicians should be aware that rifabutin is a potential treatment for bartonellosis, and that rifabutin can cause visually significant corneal deposits. Multidisciplinary management is crucial for patients with corneal deposits associated with rifabutin therapy. • Rifabutin can cause visually significant corneal deposits. • Histopathology localizes these deposits to the deep stroma. • The corneal deposits may be due to the high lipid solubility of rifabutin. • Rifabutin is a potential treatment for Bartonella infections. • Management of associated corneal deposits requires multidisciplinary collaboration.