{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T10:01:06Z","timestamp":1789207266587,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Recurrent cytomegalovirus retinitis (CMVR) and rare opportunistic pulmonary infections may be the initial manifestations of underlying immunodeficiency caused by occult hematologic malignancy. Epstein\u2013Barr virus-positive diffuse large B-cell lymphoma, not otherwise specified (EBV\n                      <jats:sup>+<\/jats:sup>\n                      DLBCL-NOS) is an aggressive lymphoma associated with immune dysfunction, predisposing patients to severe opportunistic infections, including CMVR. However, pulmonary co-infection with\n                      <jats:italic>Tropheryma whipplei<\/jats:italic>\n                      and\n                      <jats:italic>Penicillium digitatum<\/jats:italic>\n                      has not been previously described as a presenting feature of EBV\n                      <jats:sup>+<\/jats:sup>\n                      DLBCL-NOS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>\n                      A 66-year-old male presented with blurred vision and was diagnosed with CMVR, with profoundly low CD4\n                      <jats:sup>+<\/jats:sup>\n                      T-cell counts (102 cells\/\u03bcL) and high cytomegalovirus (CMV) DNA levels in blood and aqueous humor. He initially responded to ganciclovir, but CMVR recurred five months later, accompanied by new pulmonary nodules. Despite negative conventional microbiological tests, metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid identified co-infection with\n                      <jats:italic>Tropheryma whipplei<\/jats:italic>\n                      and\n                      <jats:italic>P. digitatum<\/jats:italic>\n                      . Broad-spectrum antimicrobial therapy led to partial clinical improvement, but pulmonary lesions persisted. PET-CT revealed hypermetabolic lung and lymph node lesions, and subsequent lung biopsy confirmed EBV\n                      <jats:sup>+<\/jats:sup>\n                      DLBCL-NOS. The patient\u2019s progressive immunodeficiency, recurrent CMVR, and refractory pulmonary infection were ultimately attributed to underlying lymphoma.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that severe, unexplained immunodeficiency with recurrent CMVR and rare opportunistic pulmonary infections should prompt a high index of suspicion for underlying hematologic malignancy. mNGS and PET-CT are critical tools in the diagnostic workup, but definitive diagnosis relies on histopathological confirmation. Early recognition of such presentations can prevent delays in diagnosing aggressive lymphomas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1732360","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:22:16Z","timestamp":1770960136000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Rare pulmonary infection and cytomegalovirus retinitis revealed a case of lymphoma"],"prefix":"10.3389","volume":"13","author":[{"given":"Jinming","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital","place":["Lishui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital","place":["Lishui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital","place":["Lishui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"961297","DOI":"10.3389\/fcimb.2022.961297","article-title":"Tropheryma whipplei detection by metagenomic next-generation sequencing in bronchoalveolar lavage fluid: a cross-sectional study","volume":"12","author":"Lin","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"961","DOI":"10.3390\/jof8090961","article-title":"Penicillium digitatum, first clinical report in Chile: fungal co-infection 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