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A case report of cryptococcal meningitis associated with ruxolitinib

Daisuke Tsukui1, Hiroaki Fujita, Keisuke Suzuki

  • 1Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan.

Medicine
|March 30, 2020
PubMed

Insights

A myelofibrosis patient on ruxolitinib developed cryptococcal meningitis. Early recognition and treatment with amphotericin B after ruxolitinib discontinuation led to recovery, highlighting a critical safety concern.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Neurology

Background:

  • Myelofibrosis is a myeloproliferative neoplasm characterized by bone marrow fibrosis.
  • Ruxolitinib is a Janus kinase (JAK) inhibitor used to treat myelofibrosis.
  • Opportunistic infections can occur in immunocompromised patients.

Observation:

  • A 76-year-old man with myelofibrosis developed fever and altered consciousness after 5 months of ruxolitinib therapy.
  • Clinical presentation included nuchal rigidity, with normal brain MRI findings.
  • Cerebrospinal fluid analysis revealed pleocytosis, low glucose, and high protein levels.

Findings:

  • Cryptococcal antigen was detected in both blood and cerebrospinal fluid (CSF).
  • Bacterial and fungal cultures from blood and CSF were negative.
  • Diagnosis of cryptococcal meningitis was confirmed despite negative cultures.

Implications:

  • Ruxolitinib therapy may increase the risk of cryptococcal meningitis in myelofibrosis patients.
  • Discontinuation of ruxolitinib and initiation of amphotericin B led to clinical improvement.
  • Physicians should maintain a high index of suspicion for cryptococcal meningitis in patients on ruxolitinib.

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