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Background Ruxolitinib (Jakafi), is an oral kinase inhibitor that works by inhibiting the activity of JAK1 and JAK2.JAK 1 and JAK 2 are molecules that play a prominent role in the signaling of cytokines, growth factors and cellular responses relevant to growth, development and immune functions in humans.Jakafi treatment is indicated for polycythemia vera, myelofibrosis, acute graft-versus-host disease, and hypereosinophilic leukemia. 1Methods Case report and review of literature.Results An 88-year-old male with hypereosinophilic leukemia (treated with Jakafi for 10 years) developed sudden cough, weight loss, hemoptysis, shortness of breath (desaturation to 80%).He had been gardening.CT scan revealed left upper lobe obliteration, nodules with ground-glass opacities (figures 1 and 2).COVID and TB testing was negative.Bronchoscopy and culture results confirmed invasive Aspergillosis pneumonia and sepsis, specifically arising from an infection by Aspergillus fumigatus.He was prescribed voriconazole for 6 months and made a complete recovery except for lung scarring.Throughout his treatment, care was taken to monitor the levels and dosages of voriconazole, Jakafi, and his prostate medications, all metabolized by the cytochrome P450 enzyme CYP3A4 in the liver Conclusions Jakafi has had great success in the treatments of various cancers. 1 Opportunistic infections during treatment is a possible complication. 2Providers and patients should be cognizant of this potentially lethal secondary infection.Preventive measures, such as HEPA filters, masks, and early detection is crucial.Monitoring and adjustment of medication and drugdrug interaction are crucial.