Klebsiella pneumoniae primary liver abscess associated with ruxolitinib
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KeywordsPrimary myelofibrosis Ruxolitinib Pyogenic liver abscess
Pyogenic liver abscess is an uncommon intra-abdominal infection associated with high mortality. The liver is in contact with massive quantities of blood from systemic and portal circulation. Therefore, any breakdown of its immune system can directly cause lethal infections. Patients with Klebsiella pneumoniae primary liver abscess (KPPLA) have higher incidences of diabetes or glucose intolerance compared to those with other pyogenic liver abscess, but it is unknown how diabetes influences the liver’s immunity including Kupffer’s cells. Here, we present a case with primary myelofibrosis (PMF) suffering from KPPLA during the course of ruxolitinib, a JAK1 and JAK2 inhibitor.
Ruxolitinib interferes with a variety of immune cells and their function [1, 2, 3]. In fact, the number and activity of immune cells were diminishing in our case: B cells, 28/μl; CD4 + T cells, 50/μl; CD8+ T cells, 53/μl; and NK-cell activity, 4 % (normal 18–40). With severe impairment of the number and activity of NK cells, JAK mutations and STAT deficiency can cause not only viral infection but also severe bacterial infections . The defect in cell-mediated immunity combined with or without impaired function of B cells might be induced by ruxolitinib, which is thought to be associated with KPPLA.
ECOG, Eastern Cooperative Oncology Group; FDP, fibrinogen degradation products; JAK, Janus kinase; KPPLA, Klebsiella pneumoniae primary liver abscess; PMF, primary myelofibrosis; PT, prothrombin time; STAT, signal transducer and activator of transcription; DIC, disseminated intravascular coagulopathy
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