Use of rifampin for treatment of disseminated tuberculosis in a patient with primary myelofibrosis on ruxolitinib

Reactivation of Pulmonary Tuberculosis following Treatment of Myelofibrosis with Ruxolitinib

“…Eight cases of TB after ruxolitinib use in patients have been previously reported in literature (Table 1) [5–7, 9–12, 18]. Dissemination of TB was reported in five of these cases [5, 7, 9, 10, 12], while the remaining two cases reported were of reactivation pulmonary TB [6] and extrapulmonary TB [11].…”

“…Dissemination of TB was reported in five of these cases [5, 7, 9, 10, 12], while the remaining two cases reported were of reactivation pulmonary TB [6] and extrapulmonary TB [11]. Therapy with ruxolitinib was withheld, and standard four-drug ATT was given in all eight cases except one [5]. Due to a relapse of MF syndromes, ruxolitinib therapy was reinitiated with success by Palandri et al and Hopman et al [9, 11].…”

“…Due to a relapse of MF syndromes, ruxolitinib therapy was reinitiated with success by Palandri et al and Hopman et al [9, 11]. Duration of treatment varied from 6 months [11] to 12 months in cases with disseminated TB [5, 9, 12]. At the completion of standard ATT, Palandri et al chose to maintain long-term prophylaxis with isoniazid with no evidence of subsequent TB reactivation [11].…”

“…At the completion of standard ATT, Palandri et al chose to maintain long-term prophylaxis with isoniazid with no evidence of subsequent TB reactivation [11]. More recently, Branco et al recently described a case of disseminated TB, occurring in a ruxolitinib treated patient, where ruxolitinib therapy was maintained while patient received rifampin [5]. …”

“…Clinical trials of ruxolitinib have not shown a significant increase in infectious complications [4]. However, several case reports have been published recently describing opportunistic infections in patients on treatment with ruxolitinib [5–15]. We report a case of reactivation pulmonary tuberculosis (TB) following ruxolitinib therapy.…”