Rapid diagnosis of a mixed pulmonary infection with Rhizopus microsporus, Aspergillus fumigatus, Pneumocystis jirovecii, and Cytomegalovirus in a Lymphoma patient using metagenomic next-generation sequencing: A case report.

Immunocompromised patients are at high risk for life-threatening polymicrobial infections, often challenging to diagnose conventionally. We report a 60-year-old male with relapsed angioimmunoblastic T-cell lymphoma, fever, and pancytopenia post-chemotherapy. Chest CT showed scattered inflammation. Bronchoalveolar lavage fluid (BALF) culture grew only Klebsiella aerogenes, but fluorescent staining revealed aseptate hyphae. Metagenomic next-generation sequencing (mNGS) of BALF identified concurrent infections with Rhizopus microsporus, Aspergillus fumigatus, Pneumocystis jirovecii, cytomegalovirus, and SARS-CoV-2 within 48 hours. Targeted therapy with isavuconazole, sulfamethoxazole-trimethoprim, and ganciclovir was promptly initiated. Despite therapy, the patient deteriorated due to profound immunodeficiency and was discharged palliatively. This case highlights mNGS as a rapid diagnostic tool for mixed infections, though clinical correlation remains essential.