Nodular Sclerosing Hodgkin Lymphoma Combined with Disseminated Talaromyces marneffei Infection: A Case Report

Abstract

Background 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.

Triple Trouble: Disseminated Penicilliosis in a Cancer patient with COVID-19

“…5 We also found one case report of nodular Hodgkin's lymphoma patient and an ovarian cancer patient infected with talaromycosis. 20,21 In the latter case, Penicillium spp. was resistant to all agents, except amphotericin-B.…”

Coexisting of Primary Central Nervous System Lymphoma and Talaromyces marneffei Brain Abscess in an AIDS Patient, A Case Report and Review of the Literature

“…We included 4 published case reports. [6][7][8][9] In 2 cases, the coexistence of Talaromyces marneffei and lymphoma was confirmed, while in the other 2 cases, Talaromyces marneffei infection was initially misdiagnosed as lymphoma. No case outside China was found during the literature search.…”

Talaromycosis from Wuhan: two-case report and literature review

“…In recent years, there have been more reports of T. marneffei infection in non-AIDS patients. Most of these patients have underlying diseases that lead to immunodeficiency, such as organ transplantation, interferon-γ autoantibodies, drug abuse, lymphoma, and leukemia ( Lee et al., 2012 , 2014 ; Chan et al., 2015 ; Tse et al., 2015 ; Guo et al., 2020 ; Yang et al., 2021b ; Gupta et al., 2022 ; Lu et al., 2020 ), but T. marneffei also occurs in non-immunodeficiency patients ( Chen et al., 2020 ). Non-HIV–infected patients are often misdiagnosed as tuberculosis (80.7%) or bacterial pneumonia (20.5%) after T. marneffei infection ( Guo et al., 2019 ).…”