Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review

Figures & data

Figure 1 Imaging appearances in case 1. (A) Enhanced chest computed tomography (CT) showing the pulmonary thromboembolism (arrow) in right inferior pulmonary artery and bilateral pleural effusion. (B) Iodine contrast esophagogram confirmed the bronchoesophageal fistula. (C) Coronal magnetic resonance imaging (MRI) showed the mediastinal soft tissue shadows (arrow) surrounded the left main bronchus.

Figure 2 CT images of case 1 in September (A) and November (B). The enlarged mediastinal lymph node (arrow) decreased after antituberculosis therapy.

Figure 3 Imaging appearances in case 2. (A) The neck abscess (arrow) on axial MRI. (B) The right psoas abscess (arrow) on axial CT.

Table 1 Published Tuberculosis Cases Related to Ruxolitinib by the End of April 2020

Age/ Sex	Underlying Disease	TB History	Screening Prior to Rux	Dose, Restart Dose (mg/Twice Daily)	Duration Before Infection	Type of Infection	Discontinuation	ATT	Restart of Rux	Outcome	Ref
NA/ M	PMF	NA	NA	NA	NA	DTB	NA	+	NA	NA	^Citation20
NA/ F	MF	No	IGRA (-) RE (-)	NA	1m	TBL	+	NA	No	Died	^Citation21
NA/ NA	MF	No	IGRA (-) RE (-)	NA	5m	TBL	No	+	-	Improved	^Citation21
62/M	PMF	NA	NA	20, 10→20	9w	DTB	+	+	+	Improved	^Citation22
82/M	PMF	No	No	20	2m	Pulmonary TB	+	+	NA	Improved	^Citation23
72/M	MF	NA	No	NA	5m	Miliary TB	+	+	NA	Died	^Citation24
68/M	MF	NA	No	NA	4w	Pulmonary TB	+	+	NA	Died	^Citation24
65/F	PPV-MF	No	NA	20→5, 5	4m	TBL	+	+	+	Improved	^Citation25
78/F	MF	NA	NA	NA	NA	DTB	+	+	NA	Improved	^Citation26
69/M	PMF	No	X-ray (-)	20, NA	3w	DTB	+	+	+	Improved	^Citation27
78/F	PMF	NA	NA	20→15	22m	DTB	No	+	-	Improved	^Citation28
64/M	PPV-MF	NA	NA	5→20	4m	TBM	NA	NA	NA	Died	^Citation29
67/M	PMF	No	NA	20	10m	Pulmonary TB	+	+	No	Improved	^Citation30
67/F	PMF	No	NA	NA, NA	6m	Ascitic fluid TB	+	+	+	Improved	^Citation30
35/F	PMF	NA	NA	20	3m	TBL	No	+	-	Improved	^Citation31
52/F	PMF	NA	NA	20, NA	8m	TBL	+	+	+	Improved	^Citation32
73/M	PMF	NA	T-SPOT.TB (+)	20→25	6m	DTB	+	+	NA	Died	^Citation33
73/M	PMF	No	No	15	6m	DTB	+	+	NA	Died	^Citation34
65/F	PPV-MF	No	No	20	47m	DTB	+	+	NA	Died	^Citation34
78/F	PMF	NA	NA	20	36m	Pulmonary TB	NA	NA	NA	Died	^Citation35
62/M	PMF	NA	NA	10, NA	13m	DTB	+	+	+	Improved	^Citation35
54/M	PMF	NA	NA	20	7m	TBL	+	+	NA	Improved	^Citation35
76/M	PV	No	NA	20	6m	TB peritonitis	+	+	NA	Improved	^Citation36
41/M	PMF	No	RE (-)	20, 10	4m	Pulmonary TB	+	+	+	Improved	Case 1
66/M	PMF	No	No	20→25→20	2m	DTB	No	+	-	Improved	Case 2

Abbreviations: NA, not available; M, male; F, female; PMF, primary myelofibrosis; MF, myelofibrosis; PPV-MF, post polycythemia vera myelofibrosis; PV, polycythemia vera; IGRA, interferon-gamma release assay; RE, radiologic examination; rux, ruxolitinib; T-SPOT.TB, T cells spot test of tuberculosis infection; m, month; w, week; DTB, disseminated tuberculosis; TB, tuberculosis; TBL, tuberculous lymphadenitis; TBM, tuberculous meningitis.

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