Sakiyama Emiko, Chinen Yoshiaki, Tsukamoto Taku, Takimoto-Shimomura Tomoko, Kuwahara-Ota Saeko, Matsumura-Kimoto Yayoi, Shimura Yuji, Kobayashi Tsutomu, Horiike Shigeo, Kuroda Junya
Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Infect Drug Resist. 2020 Apr 8;13:1017-1021. doi: 10.2147/IDR.S249030. eCollection 2020.
Ruxolitinib is a selective JAK1/2 inhibitor that is widely used for the treatment of myeloproliferative neoplasms (MPNs), including myelofibrosis and polycythemia vera (PV). Despite its clinical efficacy for MPNs, ruxolitinib possesses immunosuppressive properties that potentially increase the risks for opportunistic infection, such as mycobacterium tuberculosis (MTB) infection, and reactivation of occult viral infection. Herein, we report the case of a 76-year-old male with PV who developed tuberculosis peritonitis under ruxolitinib therapy for 28 weeks. While previous studies and case reports have suggested an increased risk of MTB infection of various organs during ruxolitinib treatment of MPNs, this case is apparently the first of tuberculosis peritonitis in a patient with MPN treated with ruxolitinib. A review of previous case reports suggests the need for careful observation for MTB from the relatively early phase of ruxolitinib treatment, given that the median duration from the start of ruxolitinib treatment to the emergence of MTB was 20 weeks (range: 3-88 weeks). Clinicians should consider tuberculosis peritonitis as a differential diagnosis when patients with MPN treated with ruxolitinib develop infectious abdominal symptoms.
芦可替尼是一种选择性JAK1/2抑制剂，广泛用于治疗骨髓增殖性肿瘤（MPN），包括骨髓纤维化和真性红细胞增多症（PV）。尽管芦可替尼对MPN具有临床疗效，但其具有免疫抑制特性，可能会增加机会性感染的风险，如结核分枝杆菌（MTB）感染以及隐匿性病毒感染的重新激活。在此，我们报告一例76岁患有PV的男性患者，在接受芦可替尼治疗28周后发生结核性腹膜炎。虽然先前的研究和病例报告表明，在MPN患者接受芦可替尼治疗期间，各器官发生MTB感染的风险增加，但该病例显然是首例接受芦可替尼治疗的MPN患者发生结核性腹膜炎。对先前病例报告的回顾表明，鉴于从开始使用芦可替尼治疗到出现MTB的中位持续时间为20周（范围：3 - 88周），需要从芦可替尼治疗的相对早期阶段就对MTB进行仔细观察。当接受芦可替尼治疗的MPN患者出现感染性腹部症状时，临床医生应将结核性腹膜炎作为鉴别诊断考虑。
