Ruxolitinib Associated Tuberculosis Presenting as a Neck Lump

Area of Science:

• Oncology
• Infectious Diseases
• Immunology

Background:

• Tuberculosis (TB) is an opportunistic infection with varied clinical presentations.
• Ruxolitinib is a Janus-activated kinase (JAK) inhibitor used to treat myelofibrosis.
• JAK inhibitors can lead to immunosuppression, potentially increasing infection risk.

Purpose of the Study:

• To report a case of miliary tuberculosis induced by Ruxolitinib.
• To highlight the importance of considering TB in patients on Ruxolitinib presenting with neck lumps.

Main Methods:

• Case report of a 78-year-old female with myelofibrosis on Ruxolitinib.
• Clinical presentation: neck lump, fever, weight loss.
• Diagnostic workup: physical examination, chest radiograph, CT scan, ultrasound-guided lymph node biopsy.
• Treatment: Ruxolitinib discontinuation and antituberculosis therapy.

Main Results:

• Patient presented with cervical lymphadenopathy and pulmonary infiltrates.
• Biopsy confirmed Mycobacterium tuberculosis infection.
• Ruxolitinib was hypothesized to cause immunosuppression leading to miliary TB.
• Treatment resulted in resolution of symptoms and radiographic findings.

Conclusions:

• Ruxolitinib-induced miliary tuberculosis can present as a neck lump.
• Clinicians should consider TB in patients on Ruxolitinib with neck masses.
• Prompt diagnosis and treatment of TB, along with Ruxolitinib discontinuation, are crucial.