Ruxolitinib Associated Tuberculosis Presenting as a Neck Lump

Abstract EN

Tuberculosis is an opportunistic infection with protean clinical manifestations.

We describe a case of Ruxolitinib induced miliary tuberculosis presenting as a neck lump.

A 78-year-old female presented with a two-month history of right-sided neck lump associated with fever, night sweats, and significant weight loss.

She had a past medical history that included myelofibrosis, being treated with Ruxolitinib.

Examination demonstrated 4 × 4 cm right-sided cervical lymphadenopathy.

A chest radiograph showed extensive shadowing in both lungs.

CT scan demonstrated perilymphatic nodes in addition to the cervical mass.

An ultrasound-guided biopsy of a cervical lymph node demonstrated confirmed Mycobacterium tuberculosis infection.

It was hypothesized that use of Ruxolitinib through its selective inhibition of Janus-activated kinases 1 and 2 resulted in immunosuppression and miliary tuberculosis in this patient.

The medication was stopped and a 12-month regime of antituberculosis therapy commenced.

She remained well at one-year follow-up with resolution of lung involvement.

Clinicians should consider tuberculosis as a differential diagnosis for patients presenting with a neck lump, particularly in those taking immunosuppressant medication such as Ruxolitinib.

A multidisciplinary approach is needed to promptly treat the tuberculosis and consider discontinuation of Ruxolitinib.