全部 标题 作者
关键词 摘要


Rapidly Growing Thyroid Mass in an Immunocompromised Young Male Adult

DOI: 10.1155/2013/290843

Full-Text   Cite this paper   Add to My Lib

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 ?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. 1. Introduction Thyroiditis by fungal organisms is infrequent. Most cases have been reported on immunocompromised patients, such as those with organ transplant, leukemias, receiving certain types of chemotherapy, subjects with human immunodeficiency virus, and others types of immunosuppression. This uncommon site of infections could be explained by the unique features of the thyroid gland [1], that includes protective mechanisms, such as rich blood supply, separation of the neck by fascial planes, high iodine content, and a fibrous capsule [2]. Among the different types of fungal thyroiditis, Aspergillus spp. are the predominant causative fungus for thyroiditis and asymptomatic thyroid infiltration [2–4]. Aspergillus thyroiditis (AT) has primarily been a postmortem diagnosis on immunocompromised patients with diagnosed disseminated invasive Aspergillosis (DIA) [5, 6]. Reports of antemortem diagnosis are rare, and for this reason in the literature it is difficult to find reports of surviving patients. Here, we report a case describing AT, in an immunocompromised young adult male with a rapidly growing thyroid mass; diagnosis was able to be performed antemortem by FNA cytology. We also review the epidemiology, clinical manifestations, diagnosis, and outcome of the different AT cases reported in the medical literature published during the years 1980–2012 through a search of the PubMed database. 2. Case A 20-year-old man was admitted to our hospital on July 2012. He was diagnosed as having an MDS one month before; by that moment he had received two courses of chemotherapy consisting of azacitidine. Admission to the hospital was due to pancytopenia and fever of

References

[1]  R. Tozzoli, O. Barzilai, M. Ram et al., “Infections and autoimmune thyroid diseases: parallel detection of antibodies against pathogens with proteomic technology,” Autoimmunity Reviews, vol. 8, no. 2, pp. 112–115, 2008.
[2]  S. A. Berger, J. Zonszein, P. Villamena, and N. Mittman, “Infectious diseases of the thyroid gland,” Reviews of Infectious Diseases, vol. 5, no. 1, pp. 108–122, 1983.
[3]  M. S. Lionakis, G. Samonis, and D. P. Kontoyiannis, “Endocrine and metabolic manifestations of invasive fungal infections and systemic antifungal treatment,” Mayo Clinic Proceedings, vol. 83, no. 9, pp. 1046–1060, 2008.
[4]  M. L. Sion, M. C. Armenaka, I. Georgiadis, G. Paraskevopoulos, and I. Nikolaidis, “Aspergillus fumigatus abscesses of the thyroid with obstruction of the esophagus,” Thyroid, vol. 14, no. 9, pp. 786–788, 2004.
[5]  J. Nguyen, R. Manera, and C. Minutti, “Aspergillus thyroiditis: a review of the literature to highlight clinical challenges,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 31, no. 12, pp. 3259–3264, 2012.
[6]  M. Vogeser, A. Haas, D. Aust, and G. Ruckdeschel, “Postmortem analysis of invasive aspergillosis in a tertiary care hospital,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 16, no. 1, pp. 1–6, 1997.
[7]  E. Solary, G. Rifle, J. M. Chalopin et al., “Disseminated aspergillosis revealed by thyroiditis in a renal allograft recipient,” Transplantation, vol. 44, no. 6, pp. 839–840, 1987.
[8]  A. M. Torres, S. Agrawal, S. Peters et al., “Invasive aspergillosis diagnosed by fine-needle aspiration of the thyroid gland,” Thyroid, vol. 9, no. 11, pp. 1119–1122, 1999.
[9]  A. R. Ayala, S. Basaria, K. E. Roberts, and D. S. Cooper, “Aspergillus thyroiditis,” Postgraduate Medical Journal, vol. 77, no. 907, article 336, 2001.
[10]  K. S. Jang, X. H. Han, Y. Oh, and S. P. Seung, “Aspergillosis of the thyroid gland diagnosed by fine needle aspiration cytology,” Acta Cytologica, vol. 48, no. 6, pp. 875–876, 2004.
[11]  L. Elzi, G. Laifer, J. Bremerich, J. Vosbeck, and M. Mayr, “Invasive apergillosis with myocardial involvement after kidney transplantation,” Nephrology Dialysis Transplantation, vol. 20, no. 3, pp. 631–634, 2005.
[12]  Y. Matsui, Y. Sugawara, K. Tsukada, Y. Kishi, J. Shibahara, and M. Makuuchi, “Aspergillus thyroiditis in a living donor liver transplant recipient,” Journal of Infection, vol. 53, no. 6, pp. e231–e233, 2006.
[13]  A. Guetgemann, V. M. Brandenburg, M. Ketteler, J. Riehl, and J. Floege, “Unclear fever 7 weeks after renal transplantation in a 56-year-old patient,” Nephrology Dialysis Transplantation, vol. 21, no. 8, pp. 2325–2327, 2006.
[14]  R. T. Gandhi, S. R. Tollin, and E. W. Seely, “Diagnosis of Candida thyroiditis by fine needle aspiration,” Journal of Infection, vol. 28, no. 1, pp. 77–81, 1994.
[15]  A. M. Avram, C. A. Sturm, C. W. Michael, J. C. Sisson, and C. A. Jaffe, “Cryptococcal thyroiditis and hyperthyroidism,” Thyroid, vol. 14, no. 6, pp. 471–474, 2004.
[16]  L. Z. Goldani, C. Klock, A. Diehl, A. C. Monteiro, and A. L. Maia, “Histoplasmosis of the thyroid,” Journal of Clinical Microbiology, vol. 38, no. 10, pp. 3890–3891, 2000.
[17]  A. Babu, E. Lacuesta, and S. Patel, “Cervical blastomycosis masquerading as a thyroid mass. This is the first reported case of extrapulmonary blastomycosis manifesting as a thyroid mass,” Endocrine Practice, vol. 11, no. 1, pp. 65–68, 2005.
[18]  J. D. Smilack and R. Argueta, “Coccidioidal infection of the thyroid,” Archives of Internal Medicine, vol. 158, no. 1, pp. 89–92, 1998.
[19]  L. Z. Goldani, A. P. Zavascki, and A. L. Maia, “Fungal thyroiditis: an overview,” Mycopathologia, vol. 161, no. 3, pp. 129–139, 2006.
[20]  D. C. Aron, “Endocrine complications of the acquired immunodeficiency syndrome,” Archives of Internal Medicine, vol. 149, no. 2, pp. 330–333, 1989.
[21]  Y. Solak, H. Atalay, A. Nar et al., “Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis,” Transplant Infectious Disease, vol. 13, no. 2, pp. 178–181, 2011.
[22]  H. Erdem, A. K. Uzunlar, U. Yildirim, M. Yildirim, and M. F. Geyik, “Diffuse infiltration of Aspergillus hyphae in the thyroid gland with multinodular goiter,” Indian Journal of Pathology and Microbiology, vol. 54, pp. 814–816, 2011.
[23]  H. W. Murray, J. O. Moore, and R. D. Luff, “Disseminated aspergillosis in a renal transplant patient: diagnostic difficulties re emphasized,” Johns Hopkins Medical Journal, vol. 137, no. 5, pp. 235–237, 1975.
[24]  Y. Kishi, M. Negishi, M. Kami et al., “Fatal airway obstruction caused by invasive aspergillosis of the thyroid gland,” Leukemia and Lymphoma, vol. 43, no. 3, pp. 669–671, 2002.
[25]  M. W. Hornef, J. Schopohl, C. Zietz et al., “Thyrotoxicosis induced by thyroid involvement of disseminated Aspergillus fumigatus infection,” Journal of Clinical Microbiology, vol. 38, no. 2, pp. 886–887, 2000.
[26]  W. M. Keane, W. P. Potsic, and L. J. Perloff, “Aspergillus thyroiditis,” Otolaryngology, vol. 86, no. 5, pp. 761–765, 1978.
[27]  C. Sergi, J. Weitz, W. J. Hofmann et al., “Aspergillus endocarditis, myocarditis and pericarditis complicating necrotizing fasciitis. Case report and subject review,” Virchows Archiv, vol. 429, no. 2-3, pp. 177–180, 1996.
[28]  G. G. Winzelberg, J. Gore, D. Yu, and A. G. Vagenakis, “Aspergillus flavus as a cause of thyroiditis in an immunosuppressed host,” Johns Hopkins Medical Journal, vol. 144, no. 3, pp. 90–93, 1979.
[29]  P. C. Iwen, M. E. Rupp, M. R. Bishop et al., “Disseminated aspergillosis caused by Aspergillus ustus in a patient following allogeneic peripheral stem cell transplantation,” Journal of Clinical Microbiology, vol. 36, no. 12, pp. 3713–3717, 1998.
[30]  P. H. Kalina and R. J. Campbell, “Aspergillus terreus endophthalmitis in a patient with chronic lymphocytic leukemia,” Archives of Ophthalmology, vol. 109, pp. 102–103, 1991.
[31]  T. Mori, M. Matsumura, K. Yamada et al., “Systemic aspergillosis caused by an aflatoxin-producing strain of Aspergillus flavus,” Journal of Medical and Veterinary Mycology, vol. 36, no. 2, pp. 107–112, 1998.
[32]  H. Narimatsu, Y. Morishita, A. Kohno et al., “Systemic infection of Aspergillus flavus in a patient with acute lymphoblastic leukemia,” Rinsho Ketsueki, vol. 44, pp. 1026–1031, 2003.
[33]  J. F. Fraumeni Jr. and R. E. Fear, “Purulent pericarditis in aspergillosis,” Annals of internal medicine, vol. 57, pp. 823–828, 1962.
[34]  G. W. Allan and D. H. Andersen, “Generalized aspergillosis in an infant 18 days of age,” Pediatrics, vol. 26, pp. 432–440, 1960.

Full-Text

comments powered by Disqus