Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review

Abstract

Background: Patients with lymphoma are at risk for developing pulmonary opportunistic infections due to immunocompromise. However, clinical reports of concurrent lymphoma and opportunistic infection at presentation are rare and often confined to single cases. A delayed diagnosis of either opportunistic infection or lymphoma usually occurs in this complex situation. Here, we report such a case and analyse 18 similar cases searched in the PubMed database to deepen clinicians' understanding. Case presentation: A 48-year-old man presented with a 3-month history of fever, cough and emaciation. Highresolution computed tomography revealed bilateral cavitating lesions of different sizes. Aspergillus fumigatus complex was identified from a bronchoalveolar lavage fluid culture. However, antifungal treatment combined with multiple rounds of antibacterial therapy was unsuccessful, and the patient's lung lesions continued to deteriorate. Multiple puncture biopsies finally confirmed the coexistence of diffuse large B-cell lymphoma. Despite the initiation of combination chemotherapy, the patient died of progressive respiratory failure. Conclusions: Synchronous pulmonary lymphoma and simultaneous opportunistic infection is rare and usually lacks specific clinical and imaging manifestations. Lymphoma should be considered as part of the differential diagnosis of patients with an opportunistic infection when treatment fails or other symptoms are present that could be considered "atypical" for the condition. Tissue biopsy is the gold standard, and multiple biopsies are essential for making the final diagnosis and should be performed upon early suspicion.

Case report: Simultaneous occurrence of primary pulmonary lymphoma and opportunistic infections in a patient with chronic myeloid leukemia

“…Afterward, the patient’s symptoms and imaging findings worsened, which prompted an alternative diagnosis. There are also some cases of co-diagnosed lymphoma and infections, such as invasive pulmonary aspergillosis ( 6 ), tuberculosis ( 22 ), and Aspergillus fumigatus ( 23 ). Regardless of the etiology, timely diagnosis and treatment are crucial.…”

“…It is common for hematological diseases to be complicated by opportunistic infections, with lung infections being the most common ( 5 ). In patients with hematological malignancies, a pulmonary infection may overshadow primary pulmonary lymphoma, posing a challenge for clinicians to diagnose and treat ( 6 ). Early identification of the second tumor is particularly important in case of co-infection, to improve outcomes with better treatment options.…”

Disseminated tuberculosis confounding a co-morbid primary CNS lymphoma

“…Indeed, for other cases of coexistent lymphoma and opportunistic infections in the same organ, clarity is often reached when patients either do not improve on empirical therapy or deteriorate in spite of it, prompting consideration of another treatment that ultimately reveals the true diagnosis. Even more often, repeat biopsy or additional invasive work-up is required beyond the first “diagnostic” test to establish true identity of the underlying disease [ 8 ]. Still further confounding is introduced by patient-specific complicating factors, such as non-infectious co-morbidities, particularly those with significant impacts on their immune status.…”

Linfomas en pacientes con VIH: una asociación compleja y frecuente. Revisión narrativa de la literatura

“…Y en el último escenario, que no es infrecuente, se debe tener en cuenta la coexistencia de una neoplasia linfoproliferativa con uno o varios oportunistas. En esta situación es indispensable contar con diferentes muestras de secreción y tejido para un cuidadoso análisis microbiológico y patológico, ojalá con disponibilidad de pruebas avanzadas de histoquímica, genética y biología molecular, para no pasar por alto ninguna de las posibilidades [21,22].…”