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

Ruxolitinib is a Janus kinase 2 inhibitor (JAK2i) used in patients with primary myelofibrosis. This treatment is a risk factor for bacterial and viral infections, and can reactivate latent infections, such as tuberculosis.

We report the case of a 80-year-old patient hospitalized for disseminated tuberculosis. He had been treated for 28 months with ruxolitinib for JAK2^V617F-muted primary myelofibrosis. Pre-therapeutic screening for latent tuberculosis infection had not been performed. Sixteen months after starting ruxolitinib, bone, peritoneal, and lymph node lesions appeared. Finally, the diagnosis of disseminated tuberculosis was made 12 months after the first secondary lesions were observed. By then, tuberculosis had caused diffuse peritoneal involvement, staged lymph node involvement, pleuropulmonary, muscular, and especially multiple bone lesions with destruction of the 6th thoracic vertebra. A treatment with quadruple antituberculosis therapy led to slow improvement. Ruxolitinib was discontinued.

Before initiating treatment with ruxolitinib, an immunological test for latent tuberculosis infection should be systematically performed, even in a country with a low tuberculosis incidence.