Infection and Drug Resistance (Dec 2021)
Nodular Sclerosing Hodgkin Lymphoma Combined with Disseminated Talaromyces marneffei Infection: A Case Report
Abstract
Zhenming Yang,1,2 Wen Zeng,2 Ye Qiu,3 Guangnan Liu,4 Jianquan Zhang1 1Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518000, People’s Republic of China; 2Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 3Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 4Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530005, People’s Republic of ChinaCorrespondence: Jianquan ZhangDepartment of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, No. 3025, Shennan Middle Road, Shenzhen, 518000, Guangdong, People’s Republic of ChinaTel +8613978123845Fax +86755-23482484Email [email protected]: Talaromyces marneffei (TM) is the only temperature-biphasic pathogen among Penicillium spp. that causes talaromycosis marneffei (TSM). Clinical manifestations include fever, cough, expectoration, superficial and deep lymph node enlargement, hepatosplenomegaly, subcutaneous nodules, and bone and joint infections. Cases of TSM in Hodgkin lymphoma (HL) patients are uncommon. The clinical manifestations and imaging findings are similar in TSM and HL, which make it difficult for clinicians to distinguish between TSM and HL. Both diseases can present with symptoms, can involve the blood or the respiratory system and can include other symptoms. We report a rare case of HIV-negative nodular sclerosing Hodgkin lymphoma (NSHL) combined with T. marneffei infection to improve clinical knowledge.Case Presentation: The patient was a 51-year-old man who presented with a 1-month history of cough, expectoration, intermittent fever in the afternoon and night, cervical lymph node enlargement, diabetes and previous lung surgery. He had markedly elevated serum inflammatory markers and moderate diffuse lung dysfunction. Chest computed tomography (CT) showed diffuse nodular lesions in both lungs with mediastinal lymph node enlargement. The patient did not respond to antibacterial and diagnostic antituberculosis therapy. After lymph node biopsy and lung culture, we obtained a definite diagnosis of NSLH with T. marneffei infection and administered antifungal therapy. His symptoms improved, and he was discharged for further treatment. Unfortunately, he died of Salmonella sepsis 7 months later.Conclusion: It is rare for NSLH patients to be infected with T. marneffei. Both diseases can present with fever, lymphadenopathy, and hepatosplenomegaly and involve the blood and respiratory system or can cause other symptoms. Clinically, a misdiagnosis or missed diagnosis may occur. A multisite biopsy or culture should be performed to make a definitive diagnosis. Early antifungal therapy combined with standard chemotherapy can achieve satisfactory clinical efficacy.Keywords: Talaromyces marneffei, nodular sclerosing Hodgkin lymphoma, identification, treatment
