A Rare Case of Suppurative Aspergillosis of the Thyroid

Suppurative fungal infection of the thyroid is an extremely rare condition even more so in an immunocompetent patient. Fungal infections of the thyroid usually occur in immunocompromised patients with hematological malignancies, recipients of bone marrow and solid organ allografts on immunosuppression, and patients with AIDS. A 65-year-old male presented with swelling in the front of the neck for 2 years. Examination revealed a ？cm non-tender, firm swelling of the right lobe of the thyroid. The patient was taken up for a subtotal thyroidectomy. Intra-operatively, an abscess cavity with pus was found in the right lobe of the thyroid. Histopathology revealed features of fungal abscess and staining demonstrated fungal hyphae characteristic of Aspergillus ssp. 1. Introduction Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus and Streptococcus species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria, Salmonella species, and anaerobes when compared with the early part of the 20th century [1]. However, thyroid infections and even more so suppurative infections are very rarely caused by mycoses. The thyroid is resistant to microbial invasion because of its rich blood supply, iodine content, and capsule [2]. Although several fungi may infect the thyroid [3], thyroid fungal infection occurs rarely and is clinically overt in a minority of patients [2, 4, 5]. Of 415 previously reported cases of infectious thyroiditis (1900–1997), only 50 (12%) were fungal [2, 4, 5]. Since then only 12 cases have been reported till date. Fungal thyroiditis has been reported in patients with immunocompromised states or in the setting of disseminated disease. This case report deals with abscess of the thyroid caused by Aspergillus spp. in a patient who presented with a lump in the front of his neck with a competent immune system. 2. Case Report A 65-years-old male diabetic patient presented with swelling in the front of the neck for 2 years (Figure 1). There was no history of recurrent fever or change in voice. There was no history of cough or hemoptysis. There was no history suggestive of hypo- or hyperthyroidism. On examination, the patient was afebrile, normotensive, moderately built, and nourished. Local examination revealed a 4？×？4 centimeter nontender, firm swelling of the right