Disseminated tuberculosis in a patient treated with a JAK2 selective inhibitor: a case report.
Disseminated tuberculosis in a patient treated with a JAK2 selective inhibitor: a case report.
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DOI：
10.1186/1756-0500-5-552
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发表时间：
2012-10-05
影响因子：
1.8
通讯作者：
Tolomeo M
中科院分区：
文献类型：
--
作者：
Colomba C;Rubino R;Siracusa L;Lalicata F;Trizzino M;Titone L;Tolomeo M
原发性骨髓纤维化是以骨髓纤维化、异常细胞因子表达、脾肿大和贫血为特征的骨髓增生性疾病。JAK2的激活和循环促炎细胞因子水平的增加似乎在骨髓纤维化的发病机制中起重要作用。已经开发了靶向JAK的新型治疗剂用于治疗骨髓增生性病症。Ruxolitinib（INCB 018424）是其中最新的药物。据我们所知，临床试验中没有证据表明JAK抑制剂治疗期间结核病风险增加。在这里，我们描述了第一例结核病患者接受Ruxolitinib治疗，男性有12年的慢性特发性骨髓纤维化病史，因为发烧，盗汗，体重减轻和左腹股沟区扩大的肿块两个月而入住我们的研究所。Ruxolitinib治疗可能由于抑制Th1应答而引发潜伏性结核病的再激活。我们的病例强调了在开始抗JAK 2治疗前准确筛查潜伏性结核病的重要性。
Primary myelofibrosis is a myeloproliferative disorder characterized by bone marrow fibrosis, abnormal cytokine expression, splenomegaly and anemia. The activation of JAK2 and the increased levels of circulating proinflammatory cytokines seem to play an important role in the pathogenesis of myelofibrosis. Novel therapeutic agents targeting JAKs have been developed for the treatment of myeloproliferative disorders. Ruxolitinib (INCB018424) is the most recent among them. To our knowledge, there is no evidence from clinical trials of an increased risk of tuberculosis during treatment with JAK inhibitors. Here we describe the first case of tuberculosis in a patient treated with Ruxolitinib, a male with a 12-year history of chronic idiopathic myelofibrosis admitted to our Institute because of fever, night sweats, weight loss and an enlarging mass in the left inguinal area for two months. Treatment with Ruxolitinib may have triggered the reactivation of latent tuberculosis because of an inhibition of Th1 response. Our case highlights the importance of an accurate screening for latent tuberculosis before starting an anti-JAK 2 treatment.