Talaromyces marneffei infection in a lung cancer patient: a rare case report

Abstract

Background: 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.

Case presentation: 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.

Conclusion: 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.

Keywords: HIV-negative; Primary pulmonary lymphoepithelioma-like carcinoma; Talaromyces marneffei.

Fig. 1

Chest CT (a-e) a) a mass and pleural effusion in the left lower lung on October 28, 2016. b) The mass in the left lower lobe was obviously smaller than that a) on November 2, 2016. c) The size of the nodule in the left lung tended to be stable with little change on April 26, 2017 (seven and a half months after taking apatinib). d) The nodule in the left lung progressed nine and a half months after taking apatinib. e) The lesions significantly improved on September 4, 2018. f) Bronchial stenosis with nodular projections. g) Yeast-like cell could be identified in the endobronchial nodule (PAS original magnification × 1000)