{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:27:19Z","timestamp":1785864439181,"version":"3.56.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive effects, and may increase the risk of opportunistic infections. Here, we report a rare case of <jats:italic>Cryptococcus neoformans<\/jats:italic> and <jats:italic>Mycobacterium haemophilum<\/jats:italic> coinfection in a myelofibrosis patient who was receiving ruxolitinib.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 70-year-old Thai man who was diagnosed with JAK2V617F-mutation-positive primary myelofibrosis had been treated with ruxolitinib for 4\u2009years. He presented with cellulitis at his left leg for 1\u2009week. Physical examination revealed fever, dyspnea, desaturation, and sign of inflammation on the left leg and ulcers on the right foot. Blood cultures showed positive for <jats:italic>C. neoformans<\/jats:italic>. He was prescribed intravenous amphotericin B deoxycholate with a subsequent switch to liposomal amphotericin B due to the development of acute kidney injury. He developed new onset of fever after 1\u2009month of antifungal treatment, and the lesion on his left leg had worsened. Biopsy of that skin lesion was sent for mycobacterial culture, and the result showed <jats:italic>M. haemophilum<\/jats:italic>. He was treated with levofloxacin, ethambutol, and rifampicin; however, the patient eventually developed septic shock and expired.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This is the first case of <jats:italic>C. neoformans<\/jats:italic> and <jats:italic>M. haemophilum<\/jats:italic> coinfection in a patient receiving ruxolitinib treatment. Although uncommon, clinicians should be aware of the potential for multiple opportunistic infections that may be caused by atypical pathogens in patients receiving ruxolitinib.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-020-05703-2","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T15:05:28Z","timestamp":1610031928000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Cryptococcal fungemia and Mycobacterium haemophilum cellulitis in a patient receiving ruxolitinib: a case report and literature review"],"prefix":"10.1186","volume":"21","author":[{"given":"Naruemit","family":"Sayabovorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piriyaporn","family":"Chongtrakool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-4914","authenticated-orcid":false,"given":"Methee","family":"Chayakulkeeree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"issue":"5","key":"5703_CR1","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1080\/23744235.2017.1390248","volume":"50","author":"MV Dioverti","year":"2018","unstructured":"Dioverti MV, Abu Saleh OM, Tande AJ. Infectious complications in patients on treatment with ruxolitinib: case report and review of the literature. Infect Dis (Lond). 2018;50(5):381\u20137.","journal-title":"Infect Dis (Lond)"},{"issue":"3","key":"5703_CR2","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1002\/ajh.24976","volume":"93","author":"F Lussana","year":"2018","unstructured":"Lussana F, Cattaneo M, Rambaldi A, Squizzato A. Ruxolitinib-associated infections: a systematic review and meta-analysis. Am J Hematol. 2018;93(3):339\u201347.","journal-title":"Am J Hematol"},{"key":"5703_CR3","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.3389\/fonc.2019.01186","volume":"9","author":"EM Elli","year":"2019","unstructured":"Elli EM, Barat\u00e8 C, Mendicino F, Palandri F, Palumbo GA. Mechanisms underlying the anti-inflammatory and immunosuppressive activity of ruxolitinib. Front Oncol. 2019;9:1186.","journal-title":"Front Oncol"},{"issue":"5","key":"5703_CR4","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1378\/chest.12-1604","volume":"143","author":"NG Wysham","year":"2013","unstructured":"Wysham NG, Sullivan DR, Allada G. An opportunistic infection associated with ruxolitinib, a novel janus kinase 1,2 inhibitor. Chest. 2013;143(5):1478\u20139.","journal-title":"Chest."},{"key":"5703_CR5","first-page":"87","volume":"22","author":"A Hirano","year":"2017","unstructured":"Hirano A, Yamasaki M, Saito N, Iwato K, Daido W, Funaishi K, Ishiyama S, Deguchi N, Taniwaki M, Ohashi N. Pulmonary cryptococcosis in a ruxolitinib-treated patient with primary myelofibrosis. Respir Med Case Rep. 2017;22:87\u201390.","journal-title":"Respir Med Case Rep"},{"issue":"1","key":"5703_CR6","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1186\/s12879-019-3922-6","volume":"19","author":"K Prakash","year":"2019","unstructured":"Prakash K, Richman D. A case report of disseminated histoplasmosis and concurrent cryptococcal meningitis in a patient treated with ruxolitinib. BMC Infect Dis. 2019;19(1):287.","journal-title":"BMC Infect Dis"},{"key":"5703_CR7","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.ijid.2019.01.002","volume":"80","author":"S Lescuyer","year":"2019","unstructured":"Lescuyer S, Ledoux MP, Gravier S, Natarajan-Am\u00e9 S, Duval C, Maloisel F, Mauvieux L, Toussaint E, Fornecker LM, Herbrecht R. Tuberculosis and atypical mycobacterial infections in ruxolitinib-treated patients with primary or secondary myelofibrosis or polycythemia vera. Int J Infect Dis. 2019;80:134\u20136.","journal-title":"Int J Infect Dis"},{"issue":"1","key":"5703_CR8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.clml.2019.08.008","volume":"20","author":"K Anand","year":"2020","unstructured":"Anand K, Burns EA, Ensor J, Rice L, Pingali SR. Mycobacterial infections with ruxolitinib: a retrospective pharmacovigilance review. Clin Lymphoma Myeloma Leuk. 2020;20(1):18\u201323.","journal-title":"Clin Lymphoma Myeloma Leuk"},{"issue":"4","key":"5703_CR9","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1111\/myc.12735","volume":"61","author":"J Liu","year":"2018","unstructured":"Liu J, Mouhayar E, Tarrand JJ, Kontoyiannis DP. Fulminant Cryptococcus neoformans infection with fatal pericardial tamponade in a patient with chronic myelomonocytic leukaemia who was treated with ruxolitinib: case report and review of fungal pericarditis. Mycoses. 2018;61(4):245\u201355.","journal-title":"Mycoses."},{"issue":"2","key":"5703_CR10","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s00277-015-2532-7","volume":"95","author":"CC Chen","year":"2016","unstructured":"Chen CC, Chen YY, Huang CE. Cryptococcal meningoencephalitis associated with the long-term use of ruxolitinib. Ann Hematol. 2016;95(2):361\u20132.","journal-title":"Ann Hematol"},{"issue":"13","key":"5703_CR11","doi-asserted-by":"publisher","first-page":"e19587","DOI":"10.1097\/MD.0000000000019587","volume":"99","author":"D Tsukui","year":"2020","unstructured":"Tsukui D, Fujita H, Suzuki K, Hirata K. A case report of cryptococcal meningitis associated with ruxolitinib. Medicine (Baltimore). 2020;99(13):e19587.","journal-title":"Medicine (Baltimore)"},{"issue":"11","key":"5703_CR12","doi-asserted-by":"publisher","first-page":"e3132","DOI":"10.3390\/cancers12113132","volume":"12","author":"P Sadjadian","year":"2020","unstructured":"Sadjadian P, Wille K, Griesshammer M. Ruxolitinib-associated infections in polycythemia vera: review of literature, clinical significance, and recommendations. Cancers (Basel). 2020;12(11):e3132.","journal-title":"Cancers (Basel)"},{"issue":"6","key":"5703_CR13","doi-asserted-by":"publisher","first-page":"ofaa167","DOI":"10.1093\/ofid\/ofaa167","volume":"7","author":"Y Kusne","year":"2020","unstructured":"Kusne Y, Kimes KE, Feller FF, Patron R, Banacloche JG, Blair JE, Vikram HR, Ampel NM. Coccidioidomycosis in patients treated with ruxolitinib. Open Forum Infect Dis. 2020;7(6):ofaa167.","journal-title":"Open Forum Infect Dis"},{"issue":"5","key":"5703_CR14","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.oftal.2018.12.006","volume":"94","author":"A Moruno-Rodr\u00edguez","year":"2019","unstructured":"Moruno-Rodr\u00edguez A, S\u00e1nchez-Vicente JL, Rueda-Rueda T, Lech\u00f3n-Caballero B, Mu\u00f1oz-Morales A, L\u00f3pez-Herrero F. Invasive aspergillosis manifesting as retinal necrosis in a patient treated with ruxolitinib. Arch Soc Esp Oftalmol. 2019;94(5):237\u201341.","journal-title":"Arch Soc Esp Oftalmol"},{"issue":"5","key":"5703_CR15","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00277-018-3242-8","volume":"97","author":"P Sylvine","year":"2018","unstructured":"Sylvine P, Thomas S, Pirayeh E. Infections associated with ruxolitinib: study in French pharmacovigilance database. Ann Hematol. 2018;97(5):913\u20134.","journal-title":"Ann Hematol"},{"issue":"5","key":"5703_CR16","first-page":"783","volume":"23","author":"B Ballesta","year":"2017","unstructured":"Ballesta B, Gonz\u00e1lez H, Mart\u00edn V, Ballesta JJ. Fatal ruxolitinib-related JC virus meningitis. J Neuro-Oncol. 2017;23(5):783\u20135.","journal-title":"J Neuro-Oncol"},{"key":"5703_CR17","doi-asserted-by":"publisher","first-page":"100269","DOI":"10.1016\/j.ensci.2020.100269","volume":"21","author":"K Nakayama","year":"2020","unstructured":"Nakayama K, Nakamura M, Konishi A, Kaneko S, Nakamichi K, Saijo M, Yakushiji Y, Kusaka H. JC virus granule cell neuronopathy associated with ruxolitinib: A case report and review of the literature. eNeurologicalSci. 2020;21:100269.","journal-title":"eNeurologicalSci"},{"key":"5703_CR18","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.2147\/IDR.S249030","volume":"13","author":"E Sakiyama","year":"2020","unstructured":"Sakiyama E, Chinen Y, Tsukamoto T, Takimoto-Shimomura T, Kuwahara-Ota S, Matsumura-Kimoto Y, Shimura Y, Kobayashi T, Horiike S, Kuroda J. Tuberculosis peritonitis during treatment of polycythemia vera with ruxolitinib. Infect Drug Resist. 2020;13:1017\u201321.","journal-title":"Infect Drug Resist"},{"issue":"10","key":"5703_CR19","doi-asserted-by":"publisher","first-page":"926","DOI":"10.3855\/jidc.9993","volume":"12","author":"MS Pepeler","year":"2018","unstructured":"Pepeler MS, \u00d6zkurt ZN, G\u00fczel \u00d6T, Aky\u00fcrek N. Tuberculosis reactivation related with ruxolitinib in a patient with primary myelofibrosis. J Infect Dev Ctries. 2018;12(10):926\u20138.","journal-title":"J Infect Dev Ctries"},{"issue":"5","key":"5703_CR20","doi-asserted-by":"publisher","first-page":"1701960","DOI":"10.1183\/13993003.01960-2017","volume":"51","author":"H Salvator","year":"2018","unstructured":"Salvator H, Berti E, Catherinot E, Rivaud E, Chabrol A, Nguyen S, Zemoura L, Cardot E, Tcherakian C, Couderc LJ. Foch Hospital Lung Immune Deficiencies Study Group. Pulmonary alveolar proteinosis and Mycobacterium abscessus lung infection related to ruxolitinib after allogeneic stem cell transplantation. Eur Respir J. 2018;51(5):1701960.","journal-title":"Eur Respir J"},{"issue":"4","key":"5703_CR21","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1128\/CMR.00020-11","volume":"24","author":"JA Lindeboom","year":"2011","unstructured":"Lindeboom JA, Bruijnesteijn van Coppenraet LE, van Soolingen D, Prins JM, Kuijper EJ. Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev. 2011;24(4):701\u201317.","journal-title":"Clin Microbiol Rev"},{"issue":"9","key":"5703_CR22","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.3201\/eid2509.190430","volume":"25","author":"P Nookeu","year":"2019","unstructured":"Nookeu P, Angkasekwinai N, Foongladda S, Phoompoung P. Clinical characteristics and treatment outcomes for patients infected with Mycobacterium haemophilum. Emerg Infect Dis. 2019;25(9):1648\u201352.","journal-title":"Emerg Infect Dis"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05703-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12879-020-05703-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05703-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T15:08:55Z","timestamp":1610032135000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-020-05703-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,7]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["5703"],"URL":"https:\/\/doi.org\/10.1186\/s12879-020-05703-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,7]]},"assertion":[{"value":"31 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article was exempted from institutional review board (IRB) approval because our center does not require IRB approval for single-case reports.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the family of the patient for publication of this case report and any accompanying images. A copy of the signed consent form is available for review by the editor of <i>BMC Infectious Diseases<\/i> upon request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}