Respiratory failure in a tofacitinib treated patient with ulcerative colitis

Tofacitinib is an oral Janus Kinase (JAK) inhibitor recently approved for the management of moderate to severe ulcerative colitis (UC). Safety data on tofacitinib has suggested a moderately increased risk for venous thromboembolism (VTE) as well as non-opportunistic infections and non-infectious drug-related lung disease. We faced a diagnostic dilemma between an infectious and non-infectious cause of acute respiratory insufficiency in a patient on recent tofacitinib therapy. A lung CT scan showed bilateral interstitial pneumonic infiltrates and a PCR on bronchoalveolar lavage fluid was positive for cytomegalovirus (CMV). The patient’s condition improved after discontinuation of tofacitinib and treatment with anti-viral drugs and high dose corticosteroids. A CMV primary infection was suspected, however a drug-induced interstitial lung disease cannot be excluded in the differential diagnosis of patients with autoimmune disorders under tofacitinib therapy who present with fever, hypoxia and pulmonary infiltrates.

Keywords: Tofacitinib, cytomegalovirus, interstitial lung disease, case report, hypoxemia, respiratory failure.