{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:30:49Z","timestamp":1786595449783,"version":"build-2736575974"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"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:p>\n                    Non-traumatic splenic rupture is an uncommon, life-threatening event and may be the first sign of an unrecognized hematological malignancy. We describe a 60-year-old man who presented with hemorrhagic shock due to splenic rupture. Emergency splenectomy controlled the bleeding and provided the diagnostic specimen. Histology supported diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), with a non-germinal-center B-cell phenotype by the Hans algorithm and a Ki-67 index of approximately 90%. Epstein-Barr virus-encoded RNA was negative. Because fluorescence\n                    <jats:italic>in situ<\/jats:italic>\n                    hybridization for MYC, BCL2, and BCL6 rearrangements was unavailable, high-grade B-cell lymphoma with rearrangements could not be excluded. Staging was incomplete; the case is therefore described as DLBCL with dominant splenic presentation rather than primary splenic DLBCL. The post-operative course was complicated by severe pneumonia. Pulmonary aspergillosis was clinically diagnosed based on the overall host profile, bronchoscopic findings, serum galactomannan positivity, BALF mNGS results, and subsequent culture. BALF mNGS detected Aspergillus fumigatus and Pseudomonas aeruginosa before culture confirmation. Voriconazole was started, but the patient died on post-operative day 11, about 24 h later. Splenic rupture was therefore the first manifestation of DLBCL, and BALF mNGS served as supportive, rather than standalone, evidence for pulmonary aspergillosis in a critically ill immunocompromised patient.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1867881","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:24:45Z","timestamp":1786595085000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Non-traumatic splenic rupture as the first presentation of diffuse large B-cell lymphoma complicated by clinically diagnosed pulmonary aspergillosis supported by metagenomic next-generation sequencing"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuyue","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, China-Japan Friendship Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1471-227X-12-11","article-title":"613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review","volume":"12","author":"Aubrey-Bassler","year":"2012","journal-title":"BMC Emerg Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"v116","DOI":"10.1093\/annonc\/mdv304","article-title":"Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Tilly","year":"2015","journal-title":"Ann Oncol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.2967\/jnumed.109.067892","article-title":"(18)F-FDG avidity in lymphoma readdressed: a study of 766 patients.","volume":"51","author":"Weiler-Sagie","year":"2010","journal-title":"J Nucl Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1182\/blood.2022015851","article-title":"The international consensus classification of mature lymphoid neoplasms: a report from the Clinical Advisory Committee","volume":"140","author":"Campo","year":"2022","journal-title":"Blood."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th edition of the World Health Organization Classification of haematolymphoid tumours: lymphoid neoplasms","volume":"36","author":"Alaggio","year":"2022","journal-title":"Leukemia."},{"key":"B6","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1182\/blood-2003-05-1545","article-title":"Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray","volume":"103","author":"Hans","year":"2004","journal-title":"Blood."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1186\/s12885-018-4702-1","article-title":"Non-traumatic splenic rupture - 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