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Review
. 2018 May 1;57(9):1297-1300.
doi: 10.2169/internalmedicine.9165-17. Epub 2017 Dec 27.

Fatal Disseminated Tuberculosis during Treatment with Ruxolitinib Plus Prednisolone in a Patient with Primary Myelofibrosis: A Case Report and Review of the Literature

Yasuhiro Tsukamoto  1   2 , Junichi Kiyasu  1   3 , Mariko Tsuda  1   2 , Motohiko Ikeda  1 , Motoaki Shiratsuchi  2 , Yoshihiro Ogawa  2 , Yuji Yufu  1
Affiliations
Review

Fatal Disseminated Tuberculosis during Treatment with Ruxolitinib Plus Prednisolone in a Patient with Primary Myelofibrosis: A Case Report and Review of the Literature

Yasuhiro Tsukamoto et al. Intern Med. .

Abstract

A 73-year-old man with primary myelofibrosis (PMF) was being treated with hydroxyurea, which was changed to ruxolitinib treatment because of worsening constitutional symptoms. Although ruxolitinib rapidly induced relief, he developed a high-grade fever. A comprehensive fever work-up found no apparent cause of the fever, except for PMF. Therefore, we increased the dose of ruxolitinib and added prednisolone, which was gradually withdrawn with resolution of the fever. However, the patient subsequently developed disseminated tuberculosis and died eight months after initiation of ruxolitinib. Our case highlights the importance of assessing and monitoring the immune status of patients receiving ruxolitinib.

Keywords: disseminated tuberculosis; primary myelofibrosis; ruxolitinib.

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Figures

Figure.
Figure.
The clinical course of the patient. Spleen enlargement was evaluated by *abdominal ultrasonography and **palpation (centimeters below the costal margin). PSL: prednisolone, HRZE: isoniazid, rifampin, pyrazinamide, and ethambutol
See this image and copyright information in PMC

References

    1. Tefferi A, Vainchenker W. Myeloproliferative neoplasms: molecular pathophysiology, essential clinical understanding, and treatment strategies. J Clin Oncol 29: 573-582, 2011. - PubMed
    1. Vannucchi AM, Kantarjian HM, Kiladjian JJ, et al. . A pooled analysis of overall survival in COMFORT-I and COMFORT-II, 2 randomized phase III trials of ruxolitinib for the treatment of myelofibrosis. Haematologica 100: 1139-1145, 2015. - PMC - PubMed
    1. Heine A, Brossart P, Wolf D. Ruxolitinib is a potent immunosuppressive compound: is it time for anti-infective prophylaxis? Blood 122: 3843-3844, 2013. - PubMed
    1. Gangat N, Caramazza D, Vaidya R, et al. . DIPSS plus: a refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status. J Clin Oncol 29: 392-397, 2011. - PubMed
    1. Yang JY, Han M, Koh Y, et al. . Effects of corticosteroids on critically ill pulmonary tuberculosis patients with acute respiratory failure: a propensity analysis of mortality. Clin Infect Dis 63: 1449-1455, 2016. - PubMed