Intra-abdominal Streptococcus agalactiae infection associated with myelofibrosis treated with ruxolitinib: a case report of an atypical clinical presentation

Abstract

Background

Post-essential thrombocythemia myelofibrosis (post-ET MF) is a type of Philadelphia chromosome-negative MF. Patients with MF treated with ruxolitinib are immunosuppressed, and therefore more at risk of infection. Several opportunistic infections can occur in the first 6 months of ruxolitinib treatment. However, cases of MF complicated by intra-abdominal Streptococcus agalactiae infection during treatment with ruxolitinib are rare.

Case report

We report the case of a 42-year-old female patient who had resumed ruxolitinib at 20 mg twice daily on 28 February 2020 and was referred for management of JAK2^V617F-positive post-ET MF on 24 April 2020. She complained of progressive abdominal distention 1 week before admission. During hospitalization, she experienced an abrupt episode of middle-grade fever without chills or peritoneal irritation. Subsequently, S. agalactiae (Group B Streptococcus, GBS) was isolated twice from ascites cultures, and an intra-abdominal infection was diagnosed. The infection was successfully treated using meropenem.

Conclusions

Our case indicates that ruxolitinib is a risk factor for GBS infection in MF patients. Accurate pathogen identification is critical for effective antimicrobial treatment and improved patient outcomes.

Keywords:

• Ruxolitinib
• myelofibrosis
• immunosuppression
• Streptococcus agalactiae
• intra-abdominal infection

Transparency

Declaration of funding

This study is supported in part by National Natural Science Funds [No. 81870104, 82070134], Tianjin Natural Science Funds [18JCZDJC34900, 16JCQNJC11400, 19JCQNJC09400], Chinese Academy of Medical Sciences Initiative Fund for Medical Sciences [No.2020-I2M-C&T-A-020, 2020-I2M-C&T-B-090].

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

J. C. analyzed the data and drafted the manuscript; Z. F. X. was the principal investigator and took primary responsibility for the paper. L. J. P., S. Q. Q., T. J. Q., Z. J. X. and Z. F. X. contributed to the clinical management. All authors reviewed and approved the final version of the manuscript.

Acknowledgements

Authors thank the participating patient and all of the authors.