Talaromyces Marneffei Infection in Lung Cancer Patients with Positive AIGAs: A Rare Case Report

Abstract

Background

Talaromyces marneffei is considered to commonly cause infection in individuals with human immunodeficiency virus (HIV) infection. However, the epidemiology of T. marneffei has changed, and an increasing number of HIV-negative but immunodeficient patients are infected with T. marneffei. The mechanisms of T. marneffei infection of HIV-negative hosts are complex and diverse. We report 2 cases of HIV-negative lung cancer with T. marneffei infection and positive anti-interferon-gamma autoantibodies (AIGAs) to provide clinical experience.

Case Presentation

We report lung adenocarcinoma combined with T. marneffei infection in HIV-negative patients, and their AIGAs were measured. Both patients were male with a family history of cancer and presented with recurrent fever and cough. The patients were negative for HIV antibodies but positive for AIGAs. Chest computed tomography (CT) showed pulmonary nodules, exudative lesions and solid changes. The patients were diagnosed with lung adenocarcinoma and Talaromycosis marneffei (TSM) by pathological examination and tissue culture. Patient 1 received only antifungal treatment, refused antitumor treatment and died in February 2019, and Patient 2 unfortunately died in April 2019 after antifungal and antitumor treatments.

Conclusion

An increasing number of HIV-negative but immunodeficient patients are infected with T. marneffei. The 2 patients in this report had lung cancer and positive AIGAs, causing immunodeficiencies, but the mechanism of T. marneffei infection in such patients is complex. Clinically, we should consider a comprehensive immunological examination to avoid the omission of other immunodeficiencies. We recommend routine testing for AIGA levels in HIV-negative marneffei patients. It is difficult to distinguish between lung cancer and disseminated TSM due to similar clinical characteristics and imaging, and multiple biopsies and cultures of diseased tissue are necessary. Early antifungal treatment and standard antitumor treatment can achieve satisfactory curative effects when a patient has both diseases.

Keywords:

• Talaromyces marneffei
• lung adenocarcinoma
• adult immunodeficiency
• anti-interferon-γ antibodies

Acknowledgments

We have received no substantial contributions from nonauthors. Fanhai Lin and Zhenming Yang are co-first authors for this study.

Abbreviations

AIGAs, anti-interferon-gamma autoantibodies; PID, primary immunodeficiency; BALF, bronchoalveolar lavage fluid; CT, computed tomography; CTPA, computed tomographic pulmonary angiography; GM, galactomannan; HIV, human immunodeficiency virus; ICU, intensive care unit; NTM, nontuberculosis mycobacteria; PAS, periodic acid-Schiff; TSM, Talaromycosis marneffei; TBLB, transbronchial lung biopsy; DCR, disease control rate; PFS, progression-free survival.

Data Sharing Statement

All the data are fully available without restriction.

Ethics Approval and Informed Consent

This study was approved by the Faculty of Medicine at The First Affiliated Hospital of Guangxi Medical University [2021(KY-E-218)]. All patients or patients’ parents provided written informed consent. The study was carried out in accordance with the principles of the Declaration of Helsinki. The first author vouches for the completeness and accuracy of the data and for the fidelity of the study to the protocol.

Consent for Publication

Signed consent was obtained for the publication of the case details from the participant.

Author Contributions

FL and ZY contributed to the study concept and design, acquisition of data (imaging features), analysis and interpretation of data, and drafting of the manuscript. YQ, WZ and GL contributed to the analysis and interpretation of the data. JZ contributed to the study concept and design, acquisition of data, analysis and interpretation of data, and revision of the article. All authors contributed to data analysis, drafted or revised the article, gave final approval of the version to be published, agreed on the journal to which the article has been submitted and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.