Miliary TB and COVID-19 Coinfection in a Patient With a History of Post-polycythemia Vera Myelofibrosis Treated With Ruxolitinib: A Case Report.

Autor:	Loutsou M; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, GRC., Georgakopoulou VE; Department of Pathophysiology/Pulmonology, Laiko General Hospital, Athens, GRC., Roussakis N; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, GRC., Chadia K; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, GRC., Steiropoulos P; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, GRC.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 03; Vol. 16 (7), pp. e63791. Date of Electronic Publication: 2024 Jul 03 (Print Publication: 2024).
DOI:	10.7759/cureus.63791
Abstrakt:	The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the diagnosis and management of tuberculosis (TB), a major public health issue. This case report discusses a 70-year-old female with post-polycythemia vera myelofibrosis (post-PV MF) treated with ruxolitinib who developed miliary TB amidst a COVID-19 infection. The patient presented with a flu-like syndrome over the past week with fatigue and weight loss the last month. When she was admitted to the hospital, the real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Despite the typical COVID-19 presentation, her clinical and radiographic features raised suspicion for disseminated TB. Diagnostic tests, including bronchoscopy and PCR for Mycobacterium tuberculosis , confirmed miliary TB. She was treated with a standard antitubercular regimen, leading to symptomatic improvement. The interplay between COVID-19 and TB is complex, with COVID-19-induced immunosuppression, particularly lymphocytopenia, facilitating TB reactivation. Additionally, ruxolitinib, a Janus kinase (JAK) inhibitor used for myelofibrosis, impairs immune defense mechanisms, increasing infection risk, including TB. Prompt and accurate diagnosis of TB in the context of COVID-19 is crucial for effective management and improved patient outcomes. Clinicians should remain vigilant for TB reactivation in patients undergoing treatments such as ruxolitinib and consider alternative diagnoses despite positive SARS-CoV-2 tests. This report highlights the necessity for a comprehensive evaluation and timely intervention to mitigate the compounded risks of COVID-19 and TB. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Loutsou et al.)
Databáze:	MEDLINE
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