JC virus granule cell neuronopathy associated with Ruxolitinib: A case report and review of the literature

Nakayama, Kentaro; Nakamura, Masataka; Konishi, Akiko; Kaneko, Satoshi; Nakamichi, Kazuo; Saijo, Masayuki; Yakushiji, Yusuke; Kusaka, Hirofumi

doi:10.1016/j.ensci.2020.100269

Cited by 11 publications

(15 citation statements)

References 10 publications

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“…Moreover, these in vitro studies are supported by several case reports of PML successfully treated with mefloquine [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37]. In PubMed, at least 21 case reports published in English were available, and these cases even included treatment without additional immune reconstitution therapy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37] (Table 3). Some clinical studies failed to show the clinical efficacy of mefloquine [23], but some points must be considered.…”

Section: Discussionmentioning

confidence: 88%

“…In vitro studies suggest that mefloquine not only has an anti-JCV property by inhibiting viral DNA replication but also sufficiently penetrates the blood brain barrier [2]. Moreover, these in vitro studies are supported by several case reports of PML successfully treated with mefloquine [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37]. In PubMed, at least 21 case reports published in English were available, and these cases even included treatment without additional immune reconstitution therapy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]37] (Table 3).…”

Section: Discussionmentioning

confidence: 93%

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Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review

et al. 2021

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Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection due to reactivation of John Cunningham virus (JCV). The diagnosis depends on evidence from clinical, imaging, and virologic studies. When the cerebrospinal fluid shows a negative polymerase chain reaction result, brain biopsy is required to confirm the diagnosis. PML has no standard treatment except for immune reconstitution. The anti-JCV effect of mefloquine, however, is supported by some studies, and if brain biopsy is difficult, a mefloquine trial can be considered. We describe a case of possible PML successfully treated with mefloquine.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 93%

Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review

et al. 2021

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“…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 – 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.…”

Section: Discussionmentioning

confidence: 99%

“…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] …”

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confidence: 99%

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

2021

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Background Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive effects, and may increase the risk of opportunistic infections. Here, we report a rare case of Cryptococcus neoformans and Mycobacterium haemophilum coinfection in a myelofibrosis patient who was receiving ruxolitinib. Case presentation A 70-year-old Thai man who was diagnosed with JAK2V617F-mutation-positive primary myelofibrosis had been treated with ruxolitinib for 4 years. He presented with cellulitis at his left leg for 1 week. Physical examination revealed fever, dyspnea, desaturation, and sign of inflammation on the left leg and ulcers on the right foot. Blood cultures showed positive for C. neoformans. He was prescribed intravenous amphotericin B deoxycholate with a subsequent switch to liposomal amphotericin B due to the development of acute kidney injury. He developed new onset of fever after 1 month of antifungal treatment, and the lesion on his left leg had worsened. Biopsy of that skin lesion was sent for mycobacterial culture, and the result showed M. haemophilum. He was treated with levofloxacin, ethambutol, and rifampicin; however, the patient eventually developed septic shock and expired. Conclusions This is the first case of C. neoformans and M. haemophilum coinfection in a patient receiving ruxolitinib treatment. Although uncommon, clinicians should be aware of the potential for multiple opportunistic infections that may be caused by atypical pathogens in patients receiving ruxolitinib.

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“…The reason for this difference is unclear, but it is possible that it relates to how the body clears the two drugs, since baricitinib is largely cleared by the kidneys and ruxolitinib is subject to a first-pass effect during liver metabolism [56] . In addition, serious adverse events have been reported for ruxolitinib, which include several cases of progressive multifocal leukoencepholapathies [68] , [69] , [70] .…”

Section: Treatment Strategiesmentioning

confidence: 99%

Clinical drug therapies and biologicals currently used or in clinical trial to treat COVID-19

Malek

Bill

Vines

2021

Biomedicine & Pharmacotherapy

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The potential emergence of SARS-CoV-2 variants capable of escaping vaccine-generated immune responses poses a looming threat to vaccination efforts and will likely prolong the duration of the COVID-19 pandemic. Additionally, the prevalence of beta coronaviruses circulating in animals and the precedent they have set in jumping into human populations indicates that they pose a continuous threat for future pandemics. Currently, only one therapeutic is approved by the U.S. Food and Drug Administration (FDA) for use in treating COVID-19, remdesivir, although other therapies are authorized for emergency use due to this pandemic being a public health emergency. In this review, twenty-four different treatments are discussed regarding their use against COVID-19 and any potential future coronavirus-associated illnesses. Their traditional use, mechanism of action against COVID-19, and efficacy in clinical trials are assessed. Six treatments evaluated are shown to significantly decrease mortality in clinical trials, and ten treatments have shown some form of clinical efficacy.

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JC virus granule cell neuronopathy associated with Ruxolitinib: A case report and review of the literature

Cited by 11 publications

References 10 publications

Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review

Progressive multifocal leukoencephalopathy successfully treated with mefloquine and literature review

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

Clinical drug therapies and biologicals currently used or in clinical trial to treat COVID-19

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