Frequent Klebsiella pneumoniae Urinary Tract Infections in a Patient Treated with Ruxolitinib

Abstract

Ruxolitinib is a targeted agent that inhibits Janus 2 Kinase and is approved for use in Polycythemia Vera and Primary Myelofibrosis. Its mechanism of action involves inhibition of cellular proliferation via the Janus kinase/signal transducer and activator of transcription proteins pathway. Ruxolitinib has different immune modulating effects that result in functional immunosuppression, leading to an increased susceptibility to certain infections. Klebsiella pneumoniae infections, in particular, were common among the reported pathogens contracted by ruxolitinib users. We report a 75-year-old male patient who had recurrent K. pneumoniae urinary tract infections while on ruxolitinib for Polycythemia Vera. This case is reported to add to the literature describing an increased susceptibility of patients to this often-resistant bacteria and to raise awareness about the immune modulating effects of JAK inhibitors.

Effects of ruxolitinib on infection in patients with myeloproliferative neoplasm: a meta-analysis

“…After the widespread use of ruxolitinib, a series of case reports regarding infections were published. For example, a PV patient experienced a reactivation of HBV after a 4-week treatment of ruxolitinib [22], primary myelofibrosis patient suffered from Epstein-Barr virus (EBV) gastric ulcer due to severe immunosuppression caused by ruxolitinib [23], and Klebsiella pneumoniae infections were also reported frequently in patients [14]. Reactivation of tuberculosis and other bacterial or viral infections were also found in MPN patients using ruxolitinib [15,24].…”

“…These may potentially result in increased infections in patients who used ruxolitinib. In recent years, cases regarding infections were reported frequently in MPN patients treated with ruxolitinib [14,15]. Research studies on infections were limited and it's necessary to assess the risk of infection in MPN patients treated with ruxolitinib.…”

Onconephrology: mitigation of renal injury in chemotherapy administration

“…This pathway and the Janus kinase inhibitors are targeted in solid organ tumors, and JAK-stat 2 inhibitors are targeted in polycythemia vera [40 ▪ ]. The main toxicity is immune modulation resulting in increased risk of infection with a variety of unusual bacteria ( Klebsiella pneumoniae ) [41]. Janus kinase TKIs are not found to be typically nephrotoxic [40 ▪ ], and JAK–stat pathway blockade is even being studied for its potential ability to ameliorate the AKI process.…”