# A case displaying the importance of JAK1 and JAK2 gene transcription in antifungal defense against coccidioidomycosis

## TL;DR

This case report highlights how inhibiting JAK1 and JAK2 genes with ruxolitinib can weaken antifungal defenses, increasing the risk of coccidioidomycosis.

## Contribution

The paper demonstrates the clinical relevance of JAK1 and JAK2 signaling in antifungal immunity through a real-world patient case.

## Key findings

- Inhibition of JAK1 and JAK2 with ruxolitinib increases susceptibility to coccidioidomycosis.
- Loss of JAK1 function impairs macrophage activation and Th1 cell responses against dimorphic fungi.
- The INF-γ-JAK1-STAT pathway is critical for antifungal defense and should be considered in JAK inhibitor therapy.

## Abstract

This case report explores the consequences of ruxolitinib via inhibition janus kinase 1 (JAK1) and JAK2 pathways in the context of fungal defense in a patient diagnosed with pulmonary coccidioidomycosis during ruxolitinib therapy for polycythemia vera. The patient experienced a relapse of pulmonary coccidioidomycosis after antifungal treatment was discontinued while continuing ruxolitinib use. This case illustrates the heightened risk of discontinuing antifungal therapy in endemic regions, emphasizing the critical need for continued monitoring. Furthermore, this case underscores the vital role of the JAK1 and JAK2 signaling cascade, particularly the interferon-gamma (INF-γ)-JAK1 and JAK2-signal transducer and activator of transcription 1 (STAT) axis, in antifungal defense. Recent studies have revealed that the loss of function in JAK1 (but not JAK2), leads to impaired macrophage activation and reduced T-helper 1 (Th1) cell responses, thereby compromising the body's ability to fight off dimorphic fungi, such as Coccidioides. Other proposed fungal immune mechanisms in the JAK-STAT pathway are discussed. Clinicians tailoring JAK inhibitor treatment options for patients must be aware of the INF-γ-JAK1-STAT pathway's pivotal role in antifungal defense.