Overt-stage primary myelofibrosis after COVID-19 infection: a case report

OBJECTIVE: Primary Myelofibrosis (PMF) is an uncommon hematological condition where the bone marrow becomes progressively fibrotic, resulting in anemia, extramedullary hematopoiesis, and splenomegaly. It is considered one of the myeloproliferative neoplasms (MPNs). The mutations in some genes, one of which is JAK, play a role in the signaling pathway in COVID-19 (Coronavirus Disease 2019), and they are also found in PMF. Currently, the connection between these diseases is not yet established. This case report aims to describe a case of overt PMF in our patient after suffering from COVID-19. CASE PRESENTATION: A 57-year-old female was referred to our hospital with the symptoms of weakness, dyspnea, low-grade fever, splenomegaly, anemia, and a history of essential thrombocytosis for 17 years ago and was on treatment until January 2022. She was diagnosed with COVID-19 in February and March 2022, and during the treatment, she presented a progressive change in the disease course. A bone marrow biopsy was done, and the patient was diagnosed with Primary Myelofibrosis. She was treated with Ruxolitinib and showed significant improvement in the first week of the treatment before becoming irresponsive. RESULTS: The PMF diagnosis is based on the patient clinical presentation, laboratory, and pathological findings following the World Health Organization (WHO) 2016 Diagnostic Criteria. Ruxolitinib was the chosen treatment for the patient, and improvement in the patient clinical condition and laboratory finding was observed. After one week, she became irresponsive to the treatment and planned to undergo AHSCT. CONCLUSIONS: No sufficient evidence proves that COVID-19 accelerates the disease progression of primary myelofibrosis. More studies on the MPN and its relation to COVID-19 are needed