Cryptococcal infection with ruxolitinib in primary myelofibrosis: A case report and literature review

Abstract

Cryptococcus neoformans (CN) is an encapsulated yeast that is found worldwide. It causes self‐limiting infections in immunocompetent hosts; however, infections due to CN could be disseminated and potentially life‐threatening in immunocompromised hosts. Herein, we present a patient with primary myelofibrosis who received ruxolitinib and developed disseminated cryptococcosis due to CN. We further discuss immune compromising factors indigenous to myeloproliferative neoplasms, ruxolitinib, and immunological pathways associated with janus kinase inhibition. We further review other cases of cryptococcal infections in patients receiving ruxolitinib reported in the literature. The report underscores the importance of suspecting infections with intracellular pathogens early in the course of illness in patients with higher rates of cumulative immunosuppression. A high clinical suspicion should be maintained when caring for such immunosuppressed patients receiving immunomodulatory agents as severe, disseminated infections can present atypically and lead to worse outcomes.

Disseminated cerebral cryptococcosis after silent West Nile virus infection in a patient with polycythemia vera: A case report and review of the literature

“… 16 As ruxolitinib is used more frequently in patients with myelofibrosis, the number of reports of cryptococcal cases and other opportunistic infections in those patients is increasing. 17 , 18 The third case of disseminated cryptococcosis of the brain was described in a patient with polycythemia vera and an unexplained monoclonal gammopathy. 5 To the best of our knowledge, our patient is the rare case of disseminated cryptococcosis of the brain in polycythemia vera patients, but the first who developed cryptococcosis following WNV infection, most likely due to impaired cell-mediated immunity.…”

Incidental diagnosis of pulmonary cryptococcosis by rebiopsy for epidermal growth factor receptor T790M mutation: A case report

“…Ruxolitinib, an inhibitor of Janus kinases 1 and 2, suppresses the immune system and potentially increases infections. Although there have been reports of of the occurrence of cryptococcosis while the patient was taking ruxolitinib, 4 according to a recent meta‐analysis, 5 ruxolitinib for myeloproliferative neoplasms increased the risk of herpes zoster infection, but there have been insufficient studies to determine the effects of ruxolitinib on the risk of overall infection. Moreover, pulmonary cryptococcosis has been reported to result in consolidation mimicking lung cancer.…”