Tsukui Daisuke, Fujita Hiroaki, Suzuki Keisuke, Hirata Koichi
Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan.
Medicine (Baltimore). 2020 Mar;99(13):e19587. doi: 10.1097/MD.0000000000019587.
We herein report a 76-year-old Japanese man with myelofibrosis who developed cryptococcal meningitis. After treatment for 5 months with ruxolitinib, the patient presented with fever and disturbance of consciousness. Marked nuchal stiffness was noted. The magnetic resonance imaging results of the brain were normal. Lumbar puncture showed an opening cerebrospinal fluid (CSF) pressure of 110 mm H2O, pleocytosis (85 mononuclear cells and 222 polymorphonuclear cells/μL), decreased CSF/serum glucose ratio (43%), and elevated protein (194 mg/dL). Blood and CSF cultures grew no bacteria or fungi. However, cryptococcal antigen was detected in the blood and CSF samples. We discontinued ruxolitinib and started administration of amphotericin B. His condition improved gradually 1 week after initiation of treatment. There have been only a few reports on cryptococcal meningitis associated with ruxolitinib. Physicians should consider the possibility of cryptococcal meningitis in patients receiving ruxolitinib.
我们在此报告一名76岁的日本骨髓纤维化男性患者，其发生了隐球菌性脑膜炎。在用芦可替尼治疗5个月后，患者出现发热和意识障碍。发现有明显的颈项强直。脑部磁共振成像结果正常。腰椎穿刺显示脑脊液（CSF）初压为110mm H2O，细胞增多（85个单核细胞和222个多形核细胞/μL），CSF/血清葡萄糖比值降低（43%），蛋白质升高（194mg/dL）。血液和CSF培养未发现细菌或真菌。然而，在血液和CSF样本中检测到隐球菌抗原。我们停用了芦可替尼并开始给予两性霉素B。治疗开始1周后他的病情逐渐好转。关于与芦可替尼相关的隐球菌性脑膜炎的报道仅有几例。医生应考虑接受芦可替尼治疗患者发生隐球菌性脑膜炎的可能性。
