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Tuberculosis reactivation related with ruxolitinib in a patient with primary myelofibrosis

Mehmet S Pepeler1, Zübeyde N Özkurt2, Özlem T Güzel3

  • 1Gazi University, Ankara,Turkey. drsezgin44@gmail.com.

Journal of Infection in Developing Countries
|February 1, 2020
PubMed

Insights

Ruxolitinib, used for primary myelofibrosis, rarely increases infection risk. This case highlights tuberculosis reactivation in a patient treated with Ruxolitinib, emphasizing the need for careful risk assessment and diagnostic considerations.

Area of Science:

  • Hematology
  • Oncology
  • Infectious Diseases

Background:

  • Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by bone marrow fibrosis.
  • Ruxolitinib, a JAK-1/JAK-2 inhibitor, is a standard treatment for PMF, reducing cytokine signaling.
  • Increased infection risk is a rare but potential side effect of Ruxolitinib therapy.

Observation:

  • A female patient with PMF treated with Ruxolitinib developed symptoms of night sweats, weight loss, and cervical lymphadenopathy.
  • Excisional biopsy of the neck mass revealed necrotizing granulomatous lymphadenitis.
  • Standard tuberculosis diagnostic tests (QuantiFERON-TB and PPD) were inconclusive.

Findings:

  • The patient was diagnosed with tuberculosis reactivation.
  • Ruxolitinib therapy was paused due to potential immunosuppression.
  • The patient successfully completed a standard antituberculosis regimen, with symptom resolution and no lymphadenopathy after six months.

Implications:

  • Ruxolitinib treatment for PMF necessitates pre-treatment screening for tuberculosis due to potential reactivation risk.
  • Tuberculosis diagnostic tests may yield false-negative results in patients receiving Ruxolitinib.
  • Clinicians should maintain a high index of suspicion for tuberculosis in PMF patients on Ruxolitinib presenting with relevant symptoms.
Keywords:
JAK-2 inhibitorPrimary myelofibrosisinfectionruxolutinibtuberculosis

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