Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China.
BMC Infect Dis. 2019 Apr 24;19(1):336. doi: 10.1186/s12879-019-3968-5.
Talaromyces marneffei is an invasive, and thermal dimorphic pathogenic fungus, whose infection is life threatening in human. Although immunocompromised patients, such as patients with human immunodeficiency virus infection and recipients of organ transplant, are susceptible hosts, infections have been recently reported in people with normal immune function. Patients with cancer may also be susceptible hosts but no case of T. marneffei infection has been reported in patients with lung cancer. In this case, we describe T. marneffei infection coexisting with primary pulmonary lymphoepithelioma-like carcinoma (LELC) in an HIV-negative patient.
A 50-year-old, previously healthy female presented with a 1-month history of cough and fever. CT scans showed a mass in the left lower lung, left pleural thickening, pleural effusion, and multiple swollen lymph nodes throughout the body. Based on the pathology of the left lung lesion, she was diagnosed with left primary pulmonary LELC complicated with T. marneffei. She received both anti-tumor and anti-fungal treatments. A subsequent CT re-examination demonstrated that the mass was absorbed remarkably after treatment. Follow up showed no tumor progression and no relapse of T. marneffei infection.
This case suggested that clinicians should pay more attention to the potential hosts of T. marneffei infection, especially those with lung cancer. Early diagnosis and treatment can improve the prognosis of T. marneffei infection coexisting with lung cancer.
马尔尼菲青霉是一种侵袭性、热双相致病真菌,其感染对人类具有致命性。虽然免疫功能低下的患者,如人类免疫缺陷病毒感染和器官移植受者,是易感宿主,但最近也有报道称免疫功能正常的人群会感染。癌症患者也可能是易感宿主,但尚未有肺癌患者感染马尔尼菲青霉的报道。在本病例中,我们描述了一名 HIV 阴性患者同时患有原发性肺淋巴上皮瘤样癌(LELC)和马尔尼菲青霉感染。
一名 50 岁、既往健康的女性,因咳嗽和发热 1 个月就诊。CT 扫描显示左肺下叶肿块、左侧胸膜增厚、胸腔积液和全身多个淋巴结肿大。根据左肺病变的病理,她被诊断为左原发性肺 LELC 合并马尔尼菲青霉感染。她接受了抗肿瘤和抗真菌治疗。随后的 CT 复查显示,治疗后肿块明显吸收。随访显示无肿瘤进展和马尔尼菲青霉感染复发。
本病例提示临床医生应更加关注马尔尼菲青霉感染的潜在宿主,尤其是肺癌患者。早期诊断和治疗可以改善同时患有肺癌和马尔尼菲青霉感染的预后。