A case report of cryptococcal meningitis associated with ruxolitinib

Abstract

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.

Cryptococcal fungemia and Mycobacterium haemophilum cellulitis in a patient receiving ruxolitinib: a case report and literature review

“…From those results, the most common opportunistic pathogens that benefit from these immune defects include bacteria, mycobacteria, viruses, and fungi, similar to those seen in human immunodeficiency virus (HIV)-related infections. The causative pathogens in previously reported cases of ruxolitinib-associated infections are summarized in Table 1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Consistent with the foregoing, it appears that Cryptococcus and nontuberculous mycobacteria were able to simultaneously infect our patient due to the downregulation of multiple cytokines.…”

“…From previous case reports of cryptococcal infection, which are summarized in Table 2 [ 4 – 6 , 9 – 11 ], 6 patients with a history of ruxolitinib treatment developed cryptococcal infection. Wysham NG, et al [ 4 ] and Hirano A, et al [ 5 ] reported 2 cases of pulmonary cryptococcosis, but the other four cases presented as fungemia, pericardial involvement, and meningitis or meningoencephalitis.…”

“…Types of organisms and infections in previously reported cases of ruxolitinib-associated infection[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] …”

COVID-19-associated opportunistic infections: a snapshot on the current reports

“…Cryptococcosis: pneumonia and pulmonary infection [ 246 – 248 ], meningoencephalitis [ 249 ], meningitis [ 250 ]…”

Fatal Disseminated Tuberculosis and Concurrent Disseminated Cryptococcosis in a Ruxolitinib-treated Patient with Primary Myelofibrosis: A Case Report and Literature Review

“…However, the inhibition of the JAK-signal transducer and activator of transcription (STAT) pathway may lead to the dysfunction of cellular immunity (5), which results in decreased production of several proinflammatory cytokines (4,(6)(7)(8)(9)(10). Consequently, various opportunistic infections related to ruxolitinib treatment have been reported previously (4,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”