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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Lung cancer coexisting with Papiliotrema flavescens infection diagnosed by next-generation sequencing: a case report
Siang Zhang1, Liangzhe Wang2,3, Qianyu Han1
1Department of Thoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Background:
Papiliotrema flavescens is a rare environmental yeast, which has been isolated from air, trees, kernels of wheat and corn, fermenting soya sauce, and cerebrospinal fluid of patient with AIDS. Additionally, it is also reported to cause subcutaneous infection in a dog. In this case, we describe primary lung adenocarcinoma coexisting with Papiliotrema flavescens infection in a female patient diagnosed by next-generation sequencing (NGS) technique, which is the first such reported case.
Case Presentation:
The patient was a 52-year-old female with recurrent cough for 3 months. Chest CT examination revealed a ground glass nodule of 17 * 23 * 18 mm in the right upper lung, and 3 new pulmonary nodules appeared around it 2 months later. The patient underwent right upper lobe lobectomy and pathology confirmed that the primary 2-cm-lesion in the right upper lobe was invasive lung adenocarcinoma, and two of the three surrounding lung nodules were pathologically suggestive of pulmonary fungal infection (not known in specific fungal types). Hence, the patient received empirical anti-fungal treatments with fluconazole 400 mg/day for a week and follow-up CT scanning showed no tumor progression and no relapse of fungal infection. The specific pathogen was eventually identified as Papiliotrema flavescens by the next-generation sequencing of pathogen.
Discussion And Conclusion:
We first reported that lung cancer coexisting with Papiliotrema flavescens infection in a female patient. The diagnosis of lung cancer with typical CT imaging features is relatively simple, while the diagnosis of lung cancer coexisting with rare fungal infection is challenging. NGS technique is an effective supplementary technique for clinical diagnosis of bacterial or fungal infectious diseases, enabling precise clinical decision-making and appropriate treatment. In this case, the lung cancer may result in a degree of immune suppression, at least locally, resulting in the formation of pulmonary fungal nodular lesions around the tumor.
Insights
This study reports the first case of primary lung adenocarcinoma coexisting with Papiliotrema flavescens infection in a female patient. Next-generation sequencing (NGS) was crucial for diagnosing this rare fungal infection alongside lung cancer.
Area of Science:
- Medical Mycology
- Pulmonology
- Oncology
Background:
- Papiliotrema flavescens is a rare yeast found in diverse environments.
- This yeast has been previously associated with subcutaneous infections in animals.
- Co-infection of P. flavescens with lung adenocarcinoma is unprecedented.
Observation:
- A 52-year-old female presented with a persistent cough and a lung nodule.
- Imaging revealed primary lung adenocarcinoma and surrounding nodules suggestive of fungal infection.
- Next-generation sequencing (NGS) identified Papiliotrema flavescens as the causative fungal agent.
Findings:
- The case represents the first documented instance of primary lung adenocarcinoma coexisting with P. flavescens infection.
- Diagnosis was confirmed through histopathology and subsequent NGS analysis.
- The patient received empirical antifungal treatment with fluconazole.
Implications:
- NGS is a valuable tool for diagnosing rare fungal infections complicating lung cancer.
- Lung cancer may create localized immune suppression, facilitating fungal infections.
- This case highlights the importance of considering rare pathogens in complex pulmonary presentations.
