SanjaiSharmaOncology

From Central Valley California Coccidioidomycosis infection in a patient with Polycythemia Vera on Ruxolitinib.  Clinical history: 63-year-old male with polycythemia vera, JAK-2 V617F mutation-positive presented with high WBC counts and thrombocytosis. He was managed with hydroxyurea treatment 6 years ago. Bone marrow biopsy two years ago was reported as chronic Idiopathic myelofibrosis. He developed progressive disease uncontrollable thrombocytosis, anorexia, and early satiety from splenomegaly.  The patient was started on Ruxolitinib (Jakafi), a Jak-1, 2 inhibitor, 20mg BID and there was an excellent response with a decrease in the spleen size with improvement in a sense of well-being. After a month the dose of Jakafi had to be lowered because of side effects to 20mg a day.  After a year of Ruxolitinib treatment, the patient noted shortness of breath and was admitted to the hospital for workup. Chest x-ray revealed bilateral pulmonary infiltrates and the IgG and IgM titers for Cocci