Disseminated talaromycosis in HIV-negative patients with lung cancer: a rare case report and literature review.

BACKGROUND

Talaromycosis has long been considered to be exclusively associated with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). In recent years, with effective control measures for HIV, the number of talaromycosis patients without HIV infection has been increasing annually. All of these patients have various immunosuppressive factors, including tumors. However, we find that talaromycosis among HIV-negative lung cancer patients remains a rarity and is without comprehensive reviews, contributing to significant gaps in clinical knowledge.

CASE PRESENTATION: We report a case of lung squamous cell carcinoma combined with Talaromyces marneffei (T.marneffei) infection in an HIV-negative patient. The patient, a male with a history of long-term smoking, presented with recurrent fever and cough. Chest computed tomography (CT) scans revealed pleural effusion and nodules. The patient was diagnosed with lung squamous cell carcinoma and talaromycosis through sputum cytology and blood/cerebrospinal fluid metagenomics next-generation sequencing (mNGS). The patient underwent only antifungal therapy and succumbed to respiratory failure, liver and kidney failure, and sepsis in January 2024, before receiving any anti-tumor therapy.

CONCLUSION

The mortality rate of talaromycosis combined with lung cancer is extremely high. Therefore, regardless of whether patients have a history of travel to endemic areas of T. marneffei infection, it is crucial to test for HIV and anti-IFN-γ autoantibodies (AIGA) in patients suspected of having a pulmonary fungal infection, as well as conducting multiple cultures of specimens from different sites and utilizing mNGS to enhance diagnostic accuracy. Additionally, it is essential to perform biopsies in various methods from multiple sites to ascertain the presence of lung cancer. With effective control of T. marneffei infection and timely diagnosis and treatment of lung cancer, there can be a significant improvement in patient survival rates.