Table 2.
Literature review for reported cases of cryptococcal infection in patients receiving ruxolitinib
| Author [Year] | Patient | Gender/Age | Clinical diagnosis | Underlying disease(s) | Ruxolitinib duration | Symptoms | Laboratory findings | Imaging | Organism/site | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Wysham N, et al. [2013] [4] | 1 | Male/66 | Pneumonia | Polycythemia vera and myelofibrosis | 18 months | Dyspnea, cough, and intermittent fever |
- Mild leukocytosis - Serum cryptococcal Ag 1:4 |
Multifocal consolidations with surrounding ground glass opacities | Cryptococcus neoformans (BAL) |
- Oral fluconazole (5 months) - Discontinue ruxolitinib |
Survived |
| Chen C, et al. [2016] [10] | 2 | Female/69 | Meningoencephalitis | Myelofibrosis | 46 months | Fever, alteration of consciousness |
- Blood chemistry: NA - CSF cryptococcal Ag 1:512 |
Normal brain imaging |
- Cryptococcus neoformans (Fungal CSF culture) |
- Amphotericin B and high-dose fluconazole | Survived |
| Hirano A, et al. [2017] [5] | 3 | Male/79 | Pulmonary nodules | Primary myelofibrosis | 6 months | Asymptomatic |
- Normal CBC - Serum cryptococcal Ag 1:8 |
Multiple pulmonary nodules | Cryptococcus spp. (TBBx) |
- Oral voriconazole (5 months) - Discontinue ruxolitinib |
Survived |
| Liu J, et al. [2018] [9] | 4 | Male/71 | Pericardial effusion | Chronic myelomonocytic leukemia | NA | Cardiac tamponade |
- Marked leukocytosis - AKI, metabolic acidosis, liver dysfunction |
Bilateral pulmonary infiltrations (CXR) |
Cryptococcus neoformans (Blood and pericardial culture) |
- IV micafungin - IV fluconazole |
Died |
| Prakash K and Richman D [2019] [6] | 5 | Male/51 | Meningitis | Polycythemia vera | 18 months | Fever, lethargy, headache, weight loss, oral ulcer |
- AKI, hyponatremia, elevated ALP - CSF pleocytosis - Serum cryptococcal Ag 1:128 |
- Innumerable rim enhancing lesions at the gray-white junction - Retrocardiac mass |
- Cryptococcus neoformans (Fungal CSF culture) - Histoplasma capsulatum |
- Amphotericin B and flucytosine - Isavuconazole - Discontinue ruxolitinib |
Survived |
| Tsukui D, et al. [2020] [11] | 6 | Male/76 | Meningitis | Myelofibrosis | 5 months | Fever, alteration of consciousness |
- Anemia with normal WBC and platelet - CSF pleocytosis - Serum cryptococcal Ag positive (qualitative) |
Normal brain imaging |
- Cryptococcus neoformans (CSF- quantitative assay titers positive 1:16) |
- Amphotericin B 37 days, then oral fluconazole - Discontinue ruxolitinib |
Survived |
Abbreviations: Ag Antigen, AKI Acute kidney injury, ALP Alkaline phosphatase, BAL Bronchoalveolar lavage, CBC Complete blood count, CSF Cerebrospinal fluid, CXR Chest X-ray, IV Intravenous, NA Not available, TBBx Transbronchial biopsy, WBC White blood cell