Ruxolitinib-associated tuberculosis - A rare complication of a novel drug!

Patil, Vinod R; Shanmukhaiah, Chandrakala; Wasekar, Nilesh; Jijina, Farah; Mohite, Aniket

doi:10.5455/ijmsph.2017.0846912092016

Cited by 4 publications

(5 citation statements)

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“…By the end of April 2020, 23 cases of ruxrelated TB were described in 17 published case reports (Table 1). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Our two cases are listed in this table and will be analyzed as well.…”

Section: Dovepressmentioning

confidence: 99%

“…25 Three patients had a history of prednisolone before or during rux therapy, and one of them had also used lenalidomide for about 17 months. 23,31,33 Several patients had concomitant diabetes, chronic liver disease or tumours, all of which could lead to different degrees of immune disorder and infection susceptibility. Screening for latent TB infection (LTBI) was only performed for five patients (including case 1).…”

Section: Dovepressmentioning

confidence: 99%

“…34 The young PV patient was the only one who experienced allogeneic transplantation after resolving TB and was clinically stable in the post-transplant period. 31 It is difficult to determine whether the TB was primary or reactivation because most cases had not been screened before and had an unknown TB history. Nevertheless, elderly patients have more chances of being exposed to TB.…”

Section: Dovepressmentioning

confidence: 99%

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<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

Peng

et al. 2020

IDR

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Background: The selective Janus-activated kinase inhibitor ruxolitinib (rux) is now widely used to treat myelofibrosis and polycythemia vera due to its remarkable effect of reducing splenomegaly and improving constitutional symptoms. With opportunistic infections secondary to rux constantly reported; however, an increasing number of studies have begun to investigate the mechanism and underlying immunosuppressive effect of rux. Case Presentation: We report two cases of tuberculosis (TB) in primary myelofibrosis patients during rux therapy. The first patient received rux soon after diagnosis, and tracheobronchial TB (TBTB) and bronchoesophageal fistula were found after 4 months. After discontinuation of rux, antituberculosis therapy (ATT) was introduced. The second patient initiated rux due to progressive splenomegaly after 7.5 years of interferon therapy and was diagnosed with disseminated TB after 2 months. He received ATT as well. His rux was maintained due to the high burden of systematic symptoms and splenomegaly. Both myelofibrosis and TB were well controlled in these patients. Conclusion: This is the first case report that describes rux-related TBTB accompanied by a bronchoesophageal fistula. Through a review of the literature, we provide supporting evidence to the finding that intrinsic disorders of myeloproliferative neoplasms and rux-induced immunologic deregulation together lead to TB. We highlight the importance of screening for latent TB infection and timely chemoprophylaxis before rux therapy. Once TB is diagnosed during treatment, rux is recommended to be stopped and active ATT should begin quickly.

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Section: Dovepressmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

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<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

Peng

et al. 2020

IDR

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“…From what we know, the only case of an isolated lymph node TBC reactivation in a ruxolitinib-treated MF patient was reported by Patil et al [4] in 2016. They described the case of an axillary nodal TBC that occurred during ruxolitinib therapy in an MF patient.…”

Section: Introductionmentioning

confidence: 98%

“…Pulmonary involvement was only evaluated with an X-ray of the chest, and ruxolitinib was continued during anti-TBC treatment. No Ziehl-Nielsen test on sputum or urine was performed in the case reported by Patil and colleagues [4]. Khalid et al [5] reported a case of pulmonary TBC in a 62-year-old man with primary MF, after 1 year of treatment with ruxolitinib.…”

Section: Introductionmentioning

confidence: 99%

Isolated Nodal TBC Reactivation in a Patient with Post-Thrombocythemia Myelofibrosis Treated with Ruxolitinib: Case Report and Review of the Literature

et al. 2021

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Ruxolitinib side effects include the most frequent hematological toxicity along with a more recently evidenced immunosuppressive activity, interfering both with the innate and adaptive immunity, and several cases of reactivation of latent infections by opportunistic agents in patients in treatment with ruxolitinib have been published in the last years. Several pathophysiological mechanisms may explain an association between ruxolitinib and opportunistic infections. From what we know, the only case of an isolated lymph node TBC reactivation in a ruxolitinib-treated myelofibrosis (MF) patient was reported by Patil et al. in 2016 [Int J Med Sci Public Health. 2017;6(3):1]. Other 10 cases describing TBC reactivations in MF patients assuming ruxolitinib and successfully treated with 4-drug anti-TBC therapy are available in the literature to date. The case we reported describes an isolated lymph nodal TBC reactivation in a patient with the diagnosis of post-essential thrombocythemia-MF during ruxolitinib treatment after a long course of interferon-a (IFN-α2b) assumed for the previous diagnosis of ET. The case we report teaches that lymphadenopathy with or without constitutional symptoms developing during ruxolitinib therapy should be considered as a possible manifestation of a TBC reactivation in patients with a previous positive TBC-exposure test. In these cases, Ziel-Nielsen testing on urine and sputum has to be performed to rule out infectiousness and eventually isolate the patient. Moreover, previous long-time exposition to IFN-α2b may be related with a higher risk for TBC reactivation in these subset of patients. We encourage reevaluation of the cohorts of patients treated with ruxolitinib in previous and current large prospective studies to study the possible correlation between previous exposition to IFN-α2b and TBC reactivation.

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COVID-19-associated opportunistic infections: a snapshot on the current reports

2021

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Treatment of the novel Coronavirus Disease 2019 (COVID-19) remains a complicated challenge, especially among patients with severe disease. In recent studies, immunosuppressive therapy has shown promising results for control of the cytokine storm syndrome (CSS) in severe cases of COVID-19. However, it is well documented that immunosuppressive agents ( e.g., corticosteroids and cytokine blockers) increase the risk of opportunistic infections. On the other hand, several opportunistic infections were reported in COVID-19 patients, including Aspergillus spp . , Candida spp . , Cryptococcus neoformans , Pneumocystis jiroveci ( carinii ), mucormycosis, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Strongyloides stercoralis, Mycobacterium tuberculosis, and Toxoplasma gondii . This review is a snapshot about the main opportunistic infections that reported among COVID-19 patients. As such, we summarized information about the main immunosuppressive agents that were used in recent clinical trials for COVID-19 patients and the risk of opportunistic infections following these treatments. We also discussed about the main challenges regarding diagnosis and treatment of COVID-19-associated opportunistic infections (CAOIs). Supplementary Information The online version contains supplementary material available at 10.1007/s10238-021-00751-7.

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Ruxolitinib-associated tuberculosis - A rare complication of a novel drug!

Cited by 4 publications

References 0 publications

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

Isolated Nodal TBC Reactivation in a Patient with Post-Thrombocythemia Myelofibrosis Treated with Ruxolitinib: Case Report and Review of the Literature

COVID-19-associated opportunistic infections: a snapshot on the current reports

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