Cervical Blastomycosis Masquerading as a Thyroid Mass

Babu, Ambika; Lacuesta, Evelyn A.; Patel, Shivani

doi:10.4158/ep.11.1.65

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…The thyroid is resistant to microbial invasion because of its rich blood supply, iodine content, and capsule. 25 Although several fungi may infect the thyroid [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] (Table 2), thyroid fungal infection occurs rarely and is clinically overt in a minority of patients. [25][26][27] Of 415 previously reported cases of infectious thyroiditis (1900-1997), only 50 (12%) were fungal.…”

Section: Mycosesmentioning

confidence: 99%

Endocrine and Metabolic Manifestations of Invasive Fungal Infections and Systemic Antifungal Treatment

Lionakis

Samonis

Kontoyiannis

2008

Mayo Clinic Proceedings

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Systemic fungal infections are increasingly reported in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts, and patients with AIDS. Mycoses may infiltrate endocrine organs and adversely affect their function or produce metabolic complications, such as hypopituitarism, hyperthyroidism or hypothyroidism, pancreatitis, hypoadrenalism, hypogonadism, hypernatremia or hyponatremia, and hypercalcemia. Antifungal agents used for prophylaxis and/or treatment of mycoses also have adverse endocrine and metabolic effects, including hypoadrenalism, hypogonadism, hypoglycemia, dyslipidemia, hypernatremia, hypocalcemia, hyperphosphatemia, hyperkalemia or hypokalemia, and hypomagnesemia. Herein, we review how mycoses and conventional systemic antifungal treatment can affect the endocrine system and cause metabolic abnormalities. If clinicians are equipped with better knowledge of the endocrine and metabolic complications of fungal infections and antifungal therapy, they can more readily recognize them and favorably affect outcome.

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Section: Mycosesmentioning

confidence: 99%

Endocrine and Metabolic Manifestations of Invasive Fungal Infections and Systemic Antifungal Treatment

Lionakis

Samonis

Kontoyiannis

2008

Mayo Clinic Proceedings

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“…Although the “gold standard” for a diagnosis of blastomycosis is a positive fungal culture, this typically takes 4–6 weeks for confirmation 3. Current serologic tests for B. dermatitidis are noninvasive and inexpensive, but also not very sensitive 2. FNA allows a specimen to be obtained quickly and for visualization of fungal organisms on a smear, and is also a very reliable diagnostic method 1…”

Section: Discussionmentioning

confidence: 99%

“…1 It can manifest as chronic pulmonary symptoms or disseminated disease. The most common route of infection is by inhalation of the conidia, or spore form, of Blastomyces into the alveoli, which subsequently transform into the yeast form 2. However, reports of extrapulmonary blastomycosis are described in as many as 25–40% of patients with pulmonary blastomycosis 2.…”

mentioning

confidence: 99%

“…The most common route of infection is by inhalation of the conidia, or spore form, of Blastomyces into the alveoli, which subsequently transform into the yeast form 2. However, reports of extrapulmonary blastomycosis are described in as many as 25–40% of patients with pulmonary blastomycosis 2. The overall incidence of blastomycosis in endemic areas is 0.3–1.5 cases/100,000 population 3…”

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confidence: 99%

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Disseminated blastomycosis diagnosed by fine‐needle aspiration of the thyroid

Harvey

Mody

Amrikachi

2010

Diagnostic Cytopathology

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Blastomycosis is an uncommon disease caused by the dimorphic fungus Blastomyces dermatitidis. It can manifest as chronic pulmonary symptoms or disseminated disease. Only three previous cases of blastomycosis involving the thyroid have been reported, of which two were diagnosed by fine-needle aspiration. We present a case of disseminated blastomycosis initially diagnosed by thyroid fine-needle aspiration. Our case was a 47-year-old man with past medical history significant for diabetes, hyperlipidemia, and chronic pancreatitis who presented with a 2-week history of fever, chills, rigors, constipation, and 10 pound weight loss. Abdominal CT revealed chronic pancreatitis and a calcified mass in the pancreas. Chest CT revealed a single 1.5-2 cm thyroid mass and innumerably small 2-3 mm pulmonary nodule bilaterally. Fine-needle aspiration of the thyroid demonstrated 10-20 μm broad-based budding yeasts with thick-walled, refractile capsules amidst a background of granulomatous inflammation, and was diagnosed as a fungal infection consistent with blastomycosis. The patient was started on treatment with itraconazole based upon the FNA diagnosis. Concurrent lung biopsy demonstrated rare possible yeast forms on histology. A specimen from the lung was sent for culture, and was positive for B. dermatitidis, confirming the diagnosis. Disseminated blastomycosis rarely involves the thyroid. However, the thyroid is amenable to fine-needle aspiration. Fungal and mycobacterial cultures and special stains for fungal organisms should be requested on all thyroid fine-needle aspiration biopsies with granulomatous inflammation.

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