We present the first known published case of a 30-year-old female on methadone maintenance treatment for opioid use disorder (OUD) diagnosed with ocular tuberculosis. Her presenting symptom of tuberculosis was vision change. Treatment on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) was initiated. Rifampin had profound induction effects on the metabolism of methadone. We describe the treatment course, potential risks and benefits, and the patient’s perspective of the experience. We recommend starting with rifabutin rather than rifampin for patients being treated for ocular tuberculosis with concomitant methadone treatment for OUD to minimize risk of adverse clinical outcomes due to a less clinically significant induction of methadone metabolism.

Keywords: Methadone; Rifampin; Rifabutin; Tuberculosis; Ocular Tuberculosis; Opioid Use Disorder