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Constitutional Symptoms Masking COVID-19 In A Patient with Primary Myelofibrosis

Constitutional symptoms of primary myelofibrosis can mask COVID-19 infection. We present the case of a patient with primary myelofibrosis on ruxolitinib who tested positive for COVID-19 as part of Hematopoietic Stem Cell Transplant (HSCT) workup. The patient was asymptomatic and took over four weeks to develop a negative COVID-19 RT-PCR test. She did not test positive for COVID-19 antibodies. Patients with hematologic malignancies such as primary myelofibrosis or patients taking immunosuppressive therapy, such as ruxolitinib, may not develop infectious symptoms from COVID-19. In addition, they may take longer to test negative and may not develop antibodies to COVID-19. Therefore, these patients may be more vulnerable to re-infection. Although ruxolitinib may contribute to immunosuppression and increased susceptibility to infection, the drug is being studied as a possible treatment for COVID-19. To improve safety and patient outcomes, it is critical to test patients for COVID-19 prior to HSCT as clinicians cannot rely on symptoms to determine infection.