Hirai Nobuyasu, Kasahara Kei, Yoshihara Shingo, Nishimura Tomoko, Omori Keitaro, Ogawa Yoshihiko, Ogawa Taku, Hishiya Naokuni, Suzuki Yuki, Yano Hisakazu, Yoshikawa Masahide, Mikasa Keiichi
Department of Pathogen, Infection and Immunity, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan.
Center for Infectious Diseases, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan.
IDCases. 2020 Jun 26;21:e00892. doi: 10.1016/j.idcr.2020.e00892. eCollection 2020.
Ruxolitinib, a Janus kinase inhibitor, considerably improves symptoms of patients with polycythemia vera and primary or secondary myelofibrosis. However, its association with the development of infectious complications is a concern. Herein, we report the case of an 80-year-old man with primary myelofibrosis who developed disseminated tuberculosis during treatment with ruxolitinib at 15 mg twice daily and prednisone at 5 mg. We also reviewed the literature on patients who developed tuberculosis during treatment with ruxolitinib. There are 13 case reports of patients who developed tuberculosis during treatment with ruxolitinib, including our case. Disseminated tuberculosis manifestations were observed in 84.6 % of the patients and 50 % of them died. Although the interferon-gamma release assay was performed for seven of the patients with six positive results at the time of tuberculosis diagnosis, none were tested before the commencement of ruxolitinib. We suggest taking a history of tuberculosis and screening for and treating latent tuberculosis before administering ruxolitinib, especially in areas where the risk of tuberculosis is high.
芦可替尼是一种Janus激酶抑制剂，可显著改善真性红细胞增多症以及原发性或继发性骨髓纤维化患者的症状。然而，其与感染性并发症的发生有关，这是一个令人担忧的问题。在此，我们报告一例80岁的原发性骨髓纤维化男性患者，在接受每日两次15毫克芦可替尼和5毫克泼尼松治疗期间发生播散性结核病。我们还回顾了有关在接受芦可替尼治疗期间发生结核病的患者的文献。包括我们的病例在内，共有13例关于在接受芦可替尼治疗期间发生结核病的患者的病例报告。84.6%的患者出现播散性结核病表现，其中50%的患者死亡。虽然对7例患者进行了干扰素-γ释放试验，在结核病诊断时6例结果为阳性，但在开始使用芦可替尼之前均未进行检测。我们建议在使用芦可替尼之前询问结核病病史并筛查和治疗潜伏性结核病，尤其是在结核病风险较高的地区。
