Case 2 was a 57-year-old male from Guangxi Province who presented with cough and fever for a week. He had a 40-year history of smoking, and his father had nasopharyngeal cancer. He was admitted to the hospital with a temperature of 38.5 C but with no abnormalities in the other physical examination parameters on January 22, 2018. His white blood cell count was 15.68x109/L, hemoglobin was 91.90 g/L, and neutrophil percentage was 74.0%. His serum albumin was 27.5 g/L. His hypersensitive C-reactive protein was 163.71 mg/L. HIV antibody testing was negative. No abnormalities were found in renal function, blood glucose, autoantibody spectrum or T lymphocyte subsets. A chest CT showed multiple nodules in the upper lobe of the left lung, a mass in the left hilar lung and a mass in the middle lobe of the right lung with mediastinal and left hilar lymph node enlargement (Figure 3A and B). Fiber bronchoscopy revealed that the trachea, main bronchus and bronchi segmentales were unobstructed, and no necrotic material or tumor was observed. TBNA of the right paratracheal lymph node and subcarinal lymph node was conducted. The pathology of those lymph nodes revealed purulent exudate and hemorrhage. He was given cefoperazone tazobartan at 2.25 g every 8 hours and vancomycin at 500 mg every 12 hours a week, but the patient had a recurrent high fever. A chest CT on January 31 showed that the pulmonary lesions had increased in size (Figure 3C and D). T. marneffei was isolated from TBNA tissues on February 4 (Figure 4A and B). Thus, voriconazole at 200 mg orally every 12 hours and amphotericin B at 30 mg/day intravenously were prescribed. However, amphotericin B was discontinued due to the development of renal impairment noted on February 13. The lung lesions were smaller 2 weeks later on February 22, 2018. He was discharged with voriconazole orally 200 mg every 12 hours. However, he repeatedly developed a cough and increased sputum in August 2018, and AIGAs were identified in his serum. There were no intracavitary neoplasms seen during tracheoscopy. TBLB was performed in the posterior segment of the upper lobe of the left lung, and TBNA of the subcarinal lymph node was repeated. TBLB revealed acute and chronic inflammation of the mucous membranes accompanied by local hemorrhage, but no cancer cells were observed. No tumor cells were found in the TBNA. We considered that the patient might have T. marneffei combined with a nontuberculosis mycobacteria (NTM) infection. Therefore, rifampin at 450 mg/day, ethambutol at 750 mg/day, moxifloxacin at 400 mg/day, and clarithromycin at 500 mg/day were started. Meanwhile, cefoperazone tazobartan 2.25 g every 8 hours + linezolamide 0.6 g every 12 hours and voriconazole 200 mg every 12 hours were used for antibacterial treatment and antifungal therapy, respectively. After one week, cefoperazone tazobartan and linezolamide were discontinued, and chest CT on August 27, 2018 showed that the lesion in the upper lobe of the left lung was larger, but the mass of the left hilum was smaller (Figure 3E and F). The patient was discharged after his temperature gradually recovered. After discharge, he continued anti-NTM and antifungal therapy. However, he presented with left-sided chest pain without fever in October 2018. A chest CT showed that the lesion in the upper lobe of the left lung had enlarged, and on November 6, 2018, the mass of the left hilar was the same as before (Figure 3G and H). An ultrasound-guided lung puncture biopsy was performed on November 12. The pathology was confirmed as infiltrating adenocarcinoma, and no epidermal growth factor receptor mutation was observed (Figure 5A-D). The anti-TNM drugs were discontinued. A positron emission tomography/computed tomography showed lung cancer in the upper lobe of the left lung with metastasis in the lower lobe of the left lung, the left hilum and mediastinal lymph node, the left 3rd and 4th ribs, and the cervical, thoracic and lumbar spine. The final diagnosis was confirmed as primary lung adenocarcinoma (cT4N2M1 stage IV) with metastasis to the lower lobe of the left lung, ribs, thoracic and lumbar vertebrae and a T. marneffei infection. He took itraconazole capsules orally at 100 mg twice a day for antifungal therapy but refused chemotherapy and chose icotinib for antitumor treatment. We did not recommend this treatment because his EGFR status was negative, and he died in April 2019.