title: Disseminated tuberculosis in a patient treated with a JAK2 selective inhibitor: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dipartimento di Scienze per la promozione della salute - Sezione di Malattie infettive, Università di Palermo, Via del Vespro, 129-90127 Palermo, Italy. claudia.colomba@libero.it
authors.forename: Claudia
authors.initials: C
authors.lastname: Colomba
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rubino
authors.forename: Lucia
authors.initials: L
authors.lastname: Siracusa
authors.forename: Francesco
authors.initials: F
authors.lastname: Lalicata
authors.forename: Marcello
authors.initials: M
authors.lastname: Trizzino
authors.forename: Lucina
authors.initials: L
authors.lastname: Titone
authors.forename: Manlio
authors.initials: M
authors.lastname: Tolomeo
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors*; D008297:Male; D009570:Nitriles; D055728:Primary Myelofibrosis / Q000188:drug therapy / Q000201:enzymology; D011720:Pyrazoles / Q000009:adverse effects*; D011743:Pyrimidines; D014376:Tuberculosis / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D009570:Nitriles; D011720:Pyrazoles; D011743:Pyrimidines; C540383:ruxolitinib; D053614:Janus Kinase 2