{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:28:30Z","timestamp":1785864510449,"version":"3.56.0"},"reference-count":42,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,13]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>We report a rare case of a patient with Janus kinase 2-positive myelofibrosis on ruxolitinib, presenting with indolent pneumonia and cavitary lung lesions. Initial transthoracic biopsy was non-specific, but thoracoscopic biopsy revealed necrotising granulomatous disease caused by <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PJP). The patient, initially treated with trimethoprim\u2013sulfamethoxazole, was switched to atovaquone due to gastrointestinal intolerance. Given the patient\u2019s immunosuppression and extensive cavitary lesions, an extended course of atovaquone was administered, guided by serial imaging, resulting in clinical and radiological improvement. Unfortunately, the patient later passed away from a severe SARS-CoV-2 infection before complete radiographic resolution was observed. This case highlights the importance of recognising atypical PJP presentations causing granulomatous disease in immunosuppressed patients. While rare, documenting such cases may improve diagnosis using less invasive methods and help determine optimal treatment durations for resolution of these atypical infections.<\/jats:p>","DOI":"10.1136\/bcr-2023-258468","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T12:06:16Z","timestamp":1725019576000},"page":"e258468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cavitary lung lesions caused by <i>Pneumocystis jirovecii<\/i> in a patient with myelofibrosis on ruxolitinib"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4914-3910","authenticated-orcid":false,"given":"Austin","family":"Ritter","sequence":"first","affiliation":[{"name":"Kent Hospital Internal Medicine, Brown University, Warwick, Rhode Island, 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