PMC5499110_01
Initial chest computed tomography and microscopic findings of the transbronchial lung biopsy specimen from the left lung (hematoxylin and eosin staining). a, b: After taking ruxolitinib for 6 months, multiple nodules were seen in both lungs. The patient was diagnosed as pulmonary cryptococcosis. c, d: The lung specimen shows fungus bodies of Cryptococcus (arrows) with granulomatous inflammation.
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A 79-year-old man with primary myelofibrosis who had been treated for 6 months with ruxolitinib showed multiple pulmonary nodules on chest computed tomography (CT) (Fig. 1a and b). Cryptococcus with granulomatous inflammation (Fig. 1c and d). Cryptococcus was not detected on bronchoalveolar lavage fluid culture.
Chest computed tomography after starting the treatment for pulmonary cryptococcosis. a, b: The findings of pulmonary cryptococcosis lesions after 2 weeks of fluconazole and subsequent 3 weeks of voriconazole concomitant with ruxolitinib administration. All pulmonary lesions progressed. c, d: The findings of pulmonary cryptococcosis lesions after 3 months of voriconazole without ruxolitinib administration. All pulmonary lesions diminished in size.
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Subsequently, the patient was treated with voriconazole 300 mg daily for 3 weeks, but the lesions worsened further (Fig. 2a and b). Three months later, the pulmonary lesions diminished in size (Fig. 2c and d).