Letter to the Editor
Ruxolitinib induced leukocytoclastic vasculitis
Vasculitis leucocítica inducida por Ruxolitinib
Division of Hematology, Adnan Menderes University Medical Faculty, Aytepe Location, Efeler 09010, Aydın, Turkey
Read
1
Timeswas read the article
0
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2387020621005751" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.11.028" "estado" => "S300" "fechaPublicacion" => "2021-11-26" "aid" => "5504" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:501" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S0025775320308332" "issn" => "00257753" "doi" => "10.1016/j.medcli.2020.11.014" "estado" => "S300" "fechaPublicacion" => "2021-11-26" "aid" => "5504" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:501" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Ruxolitinib induced leukocytoclastic vasculitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "501" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis leucocítica inducida por Ruxolitinib" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Atakan Turgutkaya, İrfan Yavaşoğlu" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Atakan" "apellidos" => "Turgutkaya" ] 1 => array:2 [ "nombre" => "İrfan" "apellidos" => "Yavaşoğlu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621005751" "doi" => "10.1016/j.medcle.2020.11.028" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621005751?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320308332?idApp=UINPBA00004N" "url" => "/00257753/0000015700000010/v1_202111140539/S0025775320308332/v1_202111140539/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020621005866" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.11.030" "estado" => "S300" "fechaPublicacion" => "2021-11-26" "aid" => "5511" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:501-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Bifocal spondylodiscitis caused by <span class="elsevierStyleItalic">Streptococcus oralis</span>: A rare complication of infective endocarditis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "501" "paginaFinal" => "503" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espondilodiscitis bifocal por <span class="elsevierStyleItalic">Streptococcus oralis</span>: complicación infrecuente de la endocarditis infecciosa" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2152 "Ancho" => 2917 "Tamanyo" => 551812 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Transesophageal echocardiogram. Left: mitral valve vegetation (arrow). Center: mitral valve regurgitation shown in the color Doppler echocardiogram (arrow). Right: mitral valve microperforation (arrow). B) Ocular fundus. Roth’s spots (arrows). C) Thoracolumbar MRI. Left: signal intensity alteration in the lower portion of vertebral body D8 (arrow). Right: decrease in the height and signal intensity of the L5-S1 intervertebral disk (arrows). D) PET-CT scan. Increased metabolic activity in vertebral bodies D8 and L5-S1 (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Águila Gordo, Marina González Peñas, Jesús Piqueras Flores" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Águila Gordo" ] 1 => array:2 [ "nombre" => "Marina" "apellidos" => "González Peñas" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Piqueras Flores" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577532030840X" "doi" => "10.1016/j.medcli.2020.11.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577532030840X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621005866?idApp=UINPBA00004N" "url" => "/23870206/0000015700000010/v2_202201010925/S2387020621005866/v2_202201010925/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621005842" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.10.004" "estado" => "S300" "fechaPublicacion" => "2021-11-26" "aid" => "5507" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;157:500" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Vulvar lichen sclerosus in Turner syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "500" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Liquen escleroso vulvar en el síndrome de Turner" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emilio García García, Pedro Agudo, Silvia Jiménez Cabeza" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Emilio" "apellidos" => "García García" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Agudo" ] 2 => array:2 [ "nombre" => "Silvia" "apellidos" => "Jiménez Cabeza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320308368" "doi" => "10.1016/j.medcli.2020.11.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320308368?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621005842?idApp=UINPBA00004N" "url" => "/23870206/0000015700000010/v2_202201010925/S2387020621005842/v2_202201010925/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Ruxolitinib induced leukocytoclastic vasculitis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "501" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Atakan Turgutkaya, İrfan Yavaşoğlu" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Atakan" "apellidos" => "Turgutkaya" "email" => array:1 [ 0 => "dryavas@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "İrfan" "apellidos" => "Yavaşoğlu" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Hematology, Adnan Menderes University Medical Faculty, Aytepe Location, Efeler 09010, Aydın, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis leucocítica inducida por Ruxolitinib" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ruxolitinib is an oral Janus kinase (JAK) inhibitor, which is used in chronic myeloproliferative neoplasms (MPN), especially in primary myelofibrosis (PMF). The beneficial effects of the drug are basically alleviation of B symptoms (as drenching night sweats, weight loss and fever) and decrease of spleen volume. It has also anti-inflammatory and immunosuppressive features.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The drug has various adverse effects (AE) such as cytopenia, diarrhea, transaminitis, propensity to opportunistic infections but as far as we know, vasculitis is not one of them.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Herein we report a PMF diagnosed patient who developed leukocytoclastic vasculitis under ruxolitinib treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Seventy-four year old male patient was diagnosed PMF in April 2019 according to the World Health Organization 2016 diagnostic criteria(due to presence of megakaryocytic atypia, increase of reticular fiber degree as +3 in the bone marrow, JAK-2 mutation positivity and exclusion of other MPN's). He had a splenomegaly size as 29<span class="elsevierStyleHsp" style=""></span>cm, detected by ultrasound. His Dynamic International Prognostic Scoring System Plus score was determined as 3 (Intermediate-2). He had previous treatments of thalidomide plus prednisolone and subsequently cladribine. Ruxolitinib therapy started in November 2019 with the dose of 10<span class="elsevierStyleHsp" style=""></span>mg twice daily. He benefitted from ruxolitinib without any AE for 7 months, until multiple nodular erythematous lesions were appeared at both legs. Antinuclear antibody (ANA) profile (including anti-ds DNA, anti Ro/La, ANCA) was negative. The biopsy showed leukocytoclastic vasculitis. No finding supportive of internal organ involvement was detected. Serologic results for hepatitis B, C and human immunodeficiency virus (HIV) were negative and no other cause could be found for the etiology. No herbal medicine history was present. Lesions regressed rapidly in a couple of days after ceasing ruxolitinib. The Naranjo Adverse Drug Reaction Probability Score was calculated as 6 points consistent with a probable reaction (The AE appeared after the drug was administered- as 2 points; There were not alternative causes that could on their own have caused the reaction - as 2 points; No reaction reappeared when a placebo was given- as 1 point; The AE was confirmed by an objective evidence as biopsy- as 1 point.).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Leukocytoclastic vasculitis is an immune complex mediated vasculitis of small vessels’ of the skin with rare internal organ involvement and can be mainly infectious or drug related. Prominent causes of drugs are hydralazine, minocycline, propylthiouracil, penicillamine, colony-stimulating factors, sulphonamides, phenytoin, isotretinoin, methotrexate and allopurinol.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> To the best of our knowledge; regarding ruxolitinib, no small vessel vasculitis was reported in the literature so far. Due to immunosuppressive and anti-inflammatory effects of the drug, it's unexpected to be a trigger of an immune complex condition.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In addition, JAK- signal transducer and activator of transcription (STAT) inhibitors as ruxolitinib are being used or under investigation for the treatment of dermatologic inflammatory diseases such as atopic dermatitis, psoriasis or cutaneous graft versus host disease.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Regarding our patient, there was no other possible etiology apparent to cause vasculitis. When the reaction occurred, he was receiving no medication other than ruxolitinib. Regression of the lesions rapidly by only ceasing the drug without initiating any anti-inflammatory treatment was considered highly supportive of drug-vasculitis relationship.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ruxolitinib is a novel drug with highly beneficial effects on symptoms, reducing spleen size and decreasing mortality.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The data about its AE's are restricted due to relatively lower experience because of its novelty. Although this AE contradicts the mechanism of ruxolitinib, the clinicians should be aware of this easily manageable situation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Written informed consent for publication was obtained from the patient.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Informed consent" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms underlying the anti-inflammatory and immunosuppressive activity of ruxolitinib" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => "E. Maria Elli" 1 => "C. Baratè" 2 => "F. Mendicino" 3 => "F. Palandri" 4 => "G.A. Palumbo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fonc.2019.01186" "Revista" => array:5 [ "tituloSerie" => "Front Oncol" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "1186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31788449" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A double-blind placebo-controlled trial of ruxolitinib for myelofibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Verstovsek" 1 => "R.A. Mesa" 2 => "J. Gotlib" 3 => "R.S. Levy" 4 => "V. Gupta" 5 => "J.F. DiPersio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1110557" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "799" "paginaFinal" => "807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22375971" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Adverse Drug Reaction Probability Scale (Naranjo) in Drug Induced Liver Injury" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2019" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical approach to cutaneous vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.-R. Chen" 1 => "J. Andrew Carlson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00128071-200809020-00001" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "71" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18284262" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "JAK inhibitors in dermatology: the promise of a new drug class" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Damsky" 1 => "B.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016 12.005" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "76" "paginaInicial" => "736" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28139263" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000010/v2_202201010925/S2387020621005751/v2_202201010925/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000010/v2_202201010925/S2387020621005751/v2_202201010925/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621005751?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
