Department of Thoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, China.
BMC Infect Dis. 2022 Aug 9;22(1):684. doi: 10.1186/s12879-022-07591-0.
Papiliotrema flavescens is a rare environmental yeast, which has been isolated from air, trees, kernels of wheat and corn, fermenting soya sauce, and cerebrospinal fluid of patient with AIDS. Additionally, it is also reported to cause subcutaneous infection in a dog. In this case, we describe primary lung adenocarcinoma coexisting with Papiliotrema flavescens infection in a female patient diagnosed by next-generation sequencing (NGS) technique, which is the first such reported case.
The patient was a 52-year-old female with recurrent cough for 3 months. Chest CT examination revealed a ground glass nodule of 17 * 23 * 18 mm in the right upper lung, and 3 new pulmonary nodules appeared around it 2 months later. The patient underwent right upper lobe lobectomy and pathology confirmed that the primary 2-cm-lesion in the right upper lobe was invasive lung adenocarcinoma, and two of the three surrounding lung nodules were pathologically suggestive of pulmonary fungal infection (not known in specific fungal types). Hence, the patient received empirical anti-fungal treatments with fluconazole 400 mg/day for a week and follow-up CT scanning showed no tumor progression and no relapse of fungal infection. The specific pathogen was eventually identified as Papiliotrema flavescens by the next-generation sequencing of pathogen.
We first reported that lung cancer coexisting with Papiliotrema flavescens infection in a female patient. The diagnosis of lung cancer with typical CT imaging features is relatively simple, while the diagnosis of lung cancer coexisting with rare fungal infection is challenging. NGS technique is an effective supplementary technique for clinical diagnosis of bacterial or fungal infectious diseases, enabling precise clinical decision-making and appropriate treatment. In this case, the lung cancer may result in a degree of immune suppression, at least locally, resulting in the formation of pulmonary fungal nodular lesions around the tumor.
黄灰孔菌是一种罕见的环境酵母，已从空气、树木、麦粒和玉米粒、发酵酱油以及艾滋病患者的脑脊液中分离出来。此外，它也有报道会引起狗的皮下感染。在本病例中，我们描述了一例女性患者通过下一代测序（NGS）技术诊断为原发性肺腺癌合并黄灰孔菌感染，这是首例此类报道。
患者为 52 岁女性，反复咳嗽 3 个月。胸部 CT 检查显示右肺上叶 172318mm 磨玻璃结节，2 个月后周围出现 3 个新的肺结节。患者接受了右上肺叶切除术，病理证实右肺上叶 2cm 原发性病变为浸润性肺腺癌，其中 3 个周围肺结节中的 2 个病理提示肺部真菌感染（具体真菌类型不详）。因此，患者接受氟康唑 400mg/天经验性抗真菌治疗 1 周，随访 CT 扫描显示肿瘤无进展，真菌感染无复发。通过病原体下一代测序最终确定病原体为黄灰孔菌。
我们首次报道了一名女性患者肺癌合并黄灰孔菌感染。具有典型 CT 影像学特征的肺癌诊断相对简单，而肺癌合并罕见真菌感染的诊断具有挑战性。NGS 技术是细菌或真菌感染性疾病临床诊断的有效辅助技术，能够实现精准的临床决策和恰当的治疗。在本病例中，肺癌可能导致局部免疫抑制程度增加，从而在肿瘤周围形成肺部真菌性结节病变。
