A case report of disseminated histoplasmosis and concurrent cryptococcal meningitis in a patient treated with ruxolitinib

Katya Prakash,Douglas Richman

doi:10.1186/s12879-019-3922-6

Abstract

BackgroundRuxolitinib is a highly potent janus kinase inhibitor that places its users at risk for various bacterial infections and viral reactivation. However new reports are also emerging that suggest greater immunosuppression and risk for fungal disease.Case presentationWe report the case of a 51 year-old veteran from Guam, treated with ruxolitinib for polycythemia vera, who developed disseminated histoplasmosis and concurrent cryptococcal meningitis.ConclusionThis case draws attention to the degree of immunosuppression that may be seen with this drug and the need for heightened vigilance for opportunistic infections in those treated with inhibitors of janus kinase/signal transducers and activators of transcription (JAK/STAT) such as ruxolitinib.

Highlights

Ruxolitinib is a highly potent janus kinase inhibitor that places its users at risk for various bacterial infections and viral reactivation
We report a case of concurrent disseminated Histoplasmosis and cryptococcal meningitis in a young patient from Guam on ruxolitinib that developed within months of starting the medication
To the best of our knowledge this is the first case of both disseminated histoplasmosis and cryptococcal meningitis

Summary

Introduction

Ruxolitinib is a highly potent janus kinase inhibitor that places its users at risk for various bacterial infections and viral reactivation. Case reports have emerged, documenting the development of Pneumocystis jiroveci pneumonitis, toxoplasmosis retinitis, progressive multifocal leukoencephalopathy (PML), as well as cryptococcal meningoencephalitis and pulmonary cryptococcus in patients treated with ruxolitinib [5,6,7,8,9]. We report a case of concurrent disseminated Histoplasmosis and cryptococcal meningitis in a young patient from Guam on ruxolitinib that developed within months of starting the medication.

Results

Conclusion