Ruxolitinib
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Intestinal perforation and enteritis: case report A woman in her late 50s [age at the time of reaction onset not clearly stated] developed intestinal perforation and enteritis during treatment with ruxolitinib for myeloproliferative neoplasm. The woman, who was admitted with splenomegaly in July 2014 at the age of 55 years, was diagnosed with myeloproliferative neoplasm. In April 2015, she was initiated on treatment with ruxolitinib 20 mg/day [dosage not stated]. Her myeloproliferative neoplasm and splenomegaly improved. However, she presented in March 2017 with symptoms of diarrhoea, fever and abdominal pain. Complications of the autoimmune disease was suspected; however, antinuclear antibody was negative. Histological examinations were consistent with ulcers and non-specific inflammation. Her ruxolitinib 20 mg/day was maintained. Eventually, in April 2017, she developed intestinal perforation. The woman underwent an emergency terminal ileum resection, along with ileostomy. A pathological examination of the resected ileum was consistent with sub-mucosal inflammation, with punched-out lesion. Signs of epithelioid granuloma, cytomegalovirus, Epstein-Barr virus or tuberculosis were absent. Her intestinal perforation recurred in May 2017, requiring another ileal resection and ileostomy. A diagnosis of ruxolitinib-related enteritis was considered and the ruxolitinib was tapered off. She developed recurrent oral aphthous ulcers and uveitis after ruxolitinib discontinuation. She was subsequently diagnosed with Behcet’s disease associated with her myeloproliferative neoplasm. Her peripheral blood analysis revealed trisomy 8. She was treated with prednisolone, infliximab and azathioprine and the symptoms improved. Author comment: "The gastrointestinal side effects of ruxolitinib, such as fatigue and diarrhea, are most common. . .In our case, inflammation and perforation of the intestines occurred during ruxolitinib treatment, and we discontinued it worrying about the side effect." "Due to infection, protracted wound healing, and drug-induced enteritis, ruxolitinib was tapered" Narazaki T, et al. Intestinal Behcet’s Disease with Primary Myelofibrosis Involving Trisomy 8. Acta Haematologica 142: 253-256, No. 4, Nov 2019. Available from: 803442543 URL: http://doi.org/10.1159/000501019 - Japan
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Reactions 4 Jan 2020 No. 1785
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