Lung cancer coexisting with Papiliotrema flavescens infection diagnosed by next-generation sequencing: a case report

Abstract

Background: 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.

Case presentation: 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.

Discussion and conclusion: 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.

Keywords: Adenocarcinoma; Case report; Lung cancer; Next-generation sequencing; Papiliotrema flavescens; Pulmonary fungal infection.

Fig. 1

Chest CT scan showed a grinded glass nodule (white arrow) in the right upper lobe

Fig. 2

Main lesion showed in CT sagital reconstruction

Fig. 3

CT showed 3 smaller lung nodules (red arrows) were found surrounding the lower polar of the main lesion (white arrow)

Fig. 4

HE stain (a ×40, b ×200) showed a typical acinar predominant adenocarcinoma in the primary lesion. Tumor consisted of primarily of acinar invasion with small area of lepidic pattern growth (red arrows)

Fig. 5

HE stain (a ×100, b ×400) showed a large number of fungal spores in the granuloma (a, b), which can be confirmed in both Grocott’s Methenamine Silver (GMS) stain (c) and Periodic Acid-Schiff (PAS) stain (d) (red arrows)