Rapidly Growing Thyroid Mass in an Immunocompromised Young Male Adult

Abstract

We describe a 20-year-old man diagnosed with a myelodysplastic syndrome (MDS), admitted to our hospital due to pancytopenia and fever of undetermined origin after myelosuppression with chemotherapy. Disseminated aspergillosis (DIA) was suspected when he developed skin and lung involvement. A rapidly growing mass was detected on the left neck area, during hospitalization. A thyroid ultrasound reported a 3.7 × 2.5 × 2.9 cm oval heterogeneous structure, suggestive of an abscess versus a hematoma. Fine needle aspiration of the thyroid revealed invasion of aspergillosis. Fungal thyroiditis is a rare occurrence. Thyroid fungal infection is difficult to diagnose; for this reason it is rarely diagnosed antemortem. To our knowledge, this is the 10th case reported in the literature in an adult where the diagnosis of fungal invasion to the thyroid was able to be corroborated antemortem by fine needle aspiration biopsy.

Painful Granulomatous Hashimoto Thyroiditis Uncovered Systemic Histoplasmosis

“…9 Pneumocystis jirovecii is the most common organism in AIDS patients, while other organisms, including Histoplasma species may occur as localized infections in immunocompetent patients, though, in the latter, a preexisting thyroid disease is usually present, such as in this case. [4][5][6][7][8] In our patient, constitutional symptoms initially attributed entirely to hypothyroidism, such as fatigue and night sweats, and presumed irritative airway symptoms such as cough were further alleviated upon initiation of antifungal therapy. This finding together with positive Histoplasma serologies and persistent Histoplasma antigen in plasma 2 months after surgery, are consistent with an underlying systemic infection that was not identified during the initial diagnostic work-up.…”

“…5 Granulomatous thyroiditis caused by other fungal species is exceedingly rare and usually occurs in the context of disseminated disease. 6 We report a case of symptomatic Hashimoto thyroiditis treated with lobectomy which subsequently uncovered a concurrent thyroid histoplasmosis during pathologic examination; this is the second report describing such an association. 7…”

A suppurative thyroiditis and perineal subcutaneous abscess related with aspergillus fumigatus: a case report and literature review

“…13 of 29 patients had primary infection in lung or airway (44.8%) and primary aspergillus thyroiditis was reported in 12 cases. Except for 1 case [25], all the other patients had critical underlying diseases: 9 cases (29.0%) of organ transplantations [7, 10, 15, 19, 21, 22, 26–29]; 11 cases (35.5%) of hematologic malignancy diseases including 2 cases of acute myelocytic leukemia (AML) (6.5%) [6, 7], 2 cases of acute lymphocytic leukemia (ALL) (6.5%) [17, 30], 3 cases of non-Hodgkin’s lymphoma (NHL) (9.7%) [11, 19, 31] and 4 cases (12.9%) of myelodysplastic syndrome (MDS) [14, 20, 31, 32]; 1 case suffered the acquired immune deficiency syndrome (AIDS) [33]; Another comorbidity was SLE in 5 patients (16.1%) [8, 12, 13, 16, 18] (Table 1).…”

“…Fever, dyspnea, and thyroid enlargement were the most common presenting symptoms. Dyspnea was the most serious presentation in 15 patients [6–8, 11, 14, 16–18, 20, 21, 24, 25, 29, 31, 32] and caused airway obstructions in 3 patients, which led to 2 deaths [11, 20]. Dysphagia was noted in 2 patient [31, 32].…”

“…Almost all of the patients received glucocorticoid and/or immunosuppressive agents, but only 10 patients [7, 11, 13, 14, 17, 18, 20, 24, 31, 33] suffered from neutropenia at the moment of aspergillosis diagnosis. Furthermore, only 2 of the neutropenia patients survived [17, 18].…”