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case_images: A chest un-enhanced CT of this case. (A) Patchy high-density shadows with poorly defined boundaries in the upper lobe of the left lung, as well as partial bronchial obstruction in the same area. (B) Multiple enlarged lymph nodes were observed in lung hilum and mediastinal region. (C, D) After standardized systemic treatment with oral voriconazole, pulmonary lesion gradually resolved, both of lung hilar and mediastinal region lymph nodes shrank obviously.
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case_images: Chest computed tomography (CT) demonstrated patchy high-density opacities in the upper lobe of the left lung and partial bronchial obstruction ( Figure 1A ). Figure 1B ). Following a course of standardized systemic therapy with oral voriconazole, the pulmonary lesion showed a gradual resolution, and there was a noticeable reduction in the size of both the lung hilar and mediastinal lymph nodes, as depicted in  Figures 1C, D .
case_images: An abdominal enhanced CT of this case. (A) Multiple enlarged lymph nodes in the mesenteric and retroperitoneum region. (B) Bilateral adrenal glands and kidneys mass. (C) After standardized systemic treatment with oral voriconazole, there was no reduction in the size of the mesenteric and retroperitoneal lymph nodes. (D) Bilateral adrenal glands and renal masses seemingly enlarged.
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case_images: Abdominal contrast-enhanced CT revealed multiple enlarged lymph nodes in the mesenteric and retroperitoneal regions, along with masses in the bilateral adrenal glands and kidneys, as illustrated in  Figures 2A, B . Despite undergoing standardized systemic treatment with oral voriconazole, there was no observed reduction in the size of the mesenteric and retroperitoneal lymph nodes, as shown in  Figure 2C . Moreover, the masses in the bilateral adrenal glands and kidneys appeared to have enlarged, as seen in  Figure 2D .
case_images: Left supraclavicular lymph node biopsy specimen. (A) HE staining shows fused granulomas that destroy the cortical area of the lymph nodes (HEx40). (B) HE staining displays a granulomatous structure with necrosis (HEx200). (C) PAS staining exhibits the presence of a transverse septum at the center of the long rod-shaped thallus (x1000 oil immersion lens). (D) Hexaammonium silver staining shows a transverse septum at the center of the long rod-shaped thallus (x1000 oil immersion lens).
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case_images: Pathology results showed structural destruction of the cortical area of the lymph node, with diffuse and well-defined granulomatous structures accompanied by necrosis ( Figures 3A, B ). Periodic Acid-Schiff (PAS) staining and hexaammonium silver staining were performed, revealing a large number of T. marneffei with transverse septum characteristics distributed in clusters ( Figures 3C, D ).
case_images: Left supraclavicular lymph node biopsy specimen. (A) HE staining depicts the growth of large diffuse tumorous small lymphoid cells that cause destruction in the medullary cord and medullary sinus area (HEx10). (B) HE staining reveals small lymphoid cells with irregular nuclei and slight chromatin clumps, nucleoli are not prominent and the cytoplasm appears transparent (x 200). (C, D) Immunohistochemical staining shows CD20 and CD79a are positive (x 100). (E, F) Immunohistochemical staining demonstrates the expression of KI-67 and CD3, outlining the nodular distribution of marginal zone lymphoma (x10).
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case_images: Biopsy specimen of the anterior segment of the left lung upper lobe. (A) HE staining shows chronic inflammation of the bronchial mucosa with loose granulomas (x 100). (B) HE staining shows a granulomatous structure with necrosis (x 200).
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case_images: The bronchial biopsy indicated chronic granulomatous inflammation with necrosis ( Figure 5 ).
case_images: (A) Bronchial lavage fluid culture on CHROMagar Candida medium at 37 C showed yeast phase. (B) Bronchial lavage fluid culture of T. marneffei in the mold phase at 25 C, characteristic red pigment production was observed. (C) Lactophenol cotton blue staining from fungal Bronchial lavage fluid culture demonstrating T. marneffei bearing phialides and chains of conidia.
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case_images: T. marneffei, which demonstrated hyaline, translucent, and septate hyphae at lower temperatures, transitioning to a yeast phase with oval-shaped thalli at higher temperatures ( Figure 6 ). These findings confirmed the presence of pulmonary T. marneffei infection.
case_images: The left renal mass biopsy specimen. (A) HE staining shows diffuse growth of lymphoid cells in the punctured tissue (x 40). (B) HE staining shows small lymphoid cells with uniform size, round shape, fine chromatin, indistinct nucleoli, and little cytoplasm (x 400). (C, D) Immunohistochemical staining shows CD20 and CD79a are positive (x 100). (E) KI-67 indicates a relatively low tumor proliferation index(x 100), and (F) Immunohistochemical staining reveals a small number of scattered CD3+ T cells in the background(x 100).
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case_images: Immunohistochemical staining indicated low expression levels of KI-67 and CD3, aligning with the characteristics observed in the supraclavicular lymph node and confirming the presence of marginal zone lymphoma ( Figure 7 ).
case_images: Bone marrow biopsy specimen. (A) HE staining shows the bone marrow is involved by nodal marginal zone lymphoma (x200); (B) Immunohistochemical staining shows that CD20 is positive (x200).
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case_images: Bone marrow aspiration further confirmed the involvement of the bone marrow by marginal zone lymphoma ( Figure 8 ).
case_images: Showed the patient's treatment process and response in detail.
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case_images: T. marneffei in the lungs, and the patient's lymphoma remained stable. To elucidate the chronological progression and interrelationships of the patient's condition, we have compiled all pertinent information in a logical, timeline-based manner ( Figure 9 ).