[Ruxolitinib, disseminated tuberculosis and primary myelofibrosis: A case study].

Area of Science:

• Oncology
• Infectious Diseases
• Pharmacology

Background:

• Ruxolitinib, a Janus kinase 2 inhibitor (JAK2i), treats primary myelofibrosis.
• JAK2 inhibitors increase the risk of bacterial and viral infections, including tuberculosis reactivation.
• Latent tuberculosis infection screening is crucial before initiating JAK2 inhibitor therapy.

Purpose of the Study:

• To report a case of disseminated tuberculosis reactivation in a patient treated with ruxolitinib.
• To emphasize the importance of pre-treatment screening for latent tuberculosis infection.

Main Methods:

• Case report of an 80-year-old patient with JAK2V617F-mutated primary myelofibrosis.
• Patient received 28 months of ruxolitinib treatment without pre-therapeutic tuberculosis screening.
• Analysis of clinical presentation, diagnostic workup, and treatment outcomes.

Main Results:

• The patient developed disseminated tuberculosis with extensive bone, peritoneal, and lymph node involvement.
• Tuberculosis reactivation occurred 16 months after starting ruxolitinib, with diagnosis delayed by 12 months.
• Treatment with quadruple antituberculosis therapy led to slow improvement, and ruxolitinib was discontinued.

Conclusions:

• Systematic immunological screening for latent tuberculosis infection is essential before initiating ruxolitinib.
• This recommendation applies even in regions with low tuberculosis incidence.
• Proactive screening can prevent severe disseminated infections associated with JAK2 inhibitor therapy.