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Tan J, Shen J, Fang Y, Zhu L, Liu Y, Gong Y, Zhu H, Hu Z, Wu G. A suppurative thyroiditis and perineal subcutaneous abscess related with aspergillus fumigatus: a case report and literature review. BMC Infect Dis 2018; 18:702. [PMID: 30587135 PMCID: PMC6307113 DOI: 10.1186/s12879-018-3617-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background Invasive aspergillosis is a complication in immunocompromised patients and commonly detected in patients with hematological malignancies, which mostly affect the lungs. Because of its high iodine content, rich blood supply and capsule, the thyroid is considered to be less prone to microbial invasion thus most infectious thyroiditis cases are caused by bacteria. However, a few case reports have described thyroid gland aspergilloses, most of which were due to disseminated invasive aspergillosis. Case presentation We first report a case of thyroid gland and subcutaneous labium majus aspergillosis in a Chinese patient who received long-term glucocorticoid treatment for systemic lupus erythematosus (SLE) and lupus nephritis, and then we reviewed 36 articles describing similar aspergillus infections in 41 patients. Conclusion We included 29 cases of diagnosed aspergillus thyroiditis and analyzed clinical findings, treatments and outcomes to provide clinical information for diagnosis and prognosis of thyroiditis caused by Aspergillus fumigatus.
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Affiliation(s)
- Jiaying Tan
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Jun Shen
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Yong Fang
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Liping Zhu
- Department of Infectious Disease, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Hechen Zhu
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Zupeng Hu
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China
| | - Gang Wu
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, People's Republic of China.
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Prasad N, Manjunath R, Bhadauria D, Marak RSK, Sharma RK, Agarwal V, Jain M, Gupta A. Mucormycosis of the Thyroid Gland: A Cataclysmic Event in Renal Allograft Recipient. Indian J Nephrol 2018; 28:232-235. [PMID: 29962676 PMCID: PMC5998715 DOI: 10.4103/ijn.ijn_192_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Invasive fungal infection is a complication seen in immunocompromised patients. A disseminated fungal infection has a high rate of mortality. Although disseminated infection is known to be seen in most organs, thyroid involvement is rarely reported. Hence, we report a fatal case of thyroid mucormycosis which resulted into laryngeal nerve paralysis and death of a renal allograft recipient.
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Affiliation(s)
- N Prasad
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R Manjunath
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R S K Marak
- Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - M Jain
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
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Aspergillus Thyroiditis after Allogeneic Hematopoietic Stem Cell Transplantation. Case Rep Hematol 2015; 2015:537187. [PMID: 26640727 PMCID: PMC4660011 DOI: 10.1155/2015/537187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022] Open
Abstract
Aspergillus thyroiditis is a rare disorder detected in immunocompromised patients during disseminated infections. Early management is essential to prevent high mortality. A 61-year-old allogeneic stem cell male recipient presented with painful thyroid nodular enlargement. He had low TSH and low free T4 levels. The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis. He was successfully treated by amphotericin B.
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Rapidly growing thyroid mass in an immunocompromised young male adult. Case Rep Endocrinol 2013; 2013:290843. [PMID: 23936688 PMCID: PMC3722978 DOI: 10.1155/2013/290843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/19/2013] [Indexed: 11/17/2022] Open
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.
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Nguyen J, Manera R, Minutti C. Aspergillus thyroiditis: a review of the literature to highlight clinical challenges. Eur J Clin Microbiol Infect Dis 2012; 31:3259-64. [DOI: 10.1007/s10096-012-1704-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
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Isolated diffuse invasive renal aspergillosis in an immunocompromized patient due to longstanding steroid treatment: a case report. CASES JOURNAL 2009; 2:6825. [PMID: 19829869 PMCID: PMC2740170 DOI: 10.4076/1757-1626-2-6825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/10/2009] [Indexed: 11/08/2022]
Abstract
A 53-year-old Indian lady suffered from type 2 diabetes and hypothyroidism and was on longstanding steroid therapy. She was urgently admitted to the hospital with a high white cell count and high creatinine. On imaging no space occupying lesions were shown. In spite of intensive therapy the patient died a week after admission. Post mortem examination revealed markedly enlarged kidneys with areas of necrosis, hemorrhagic infarction, inflammatory response and granulomas related to the widespread glomerular, tubulo-interstitial and vascular involvement by aspergillus. Renal disease may present as bilateral diffuse parenchymal involvement with blood vessel invasion causing organ failure.
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Söllmann C, Trautner H, Papenfuss T, Lange M, Roewer N. [Tension pneumothorax after acute airway displacement due to pulmonary aspergillosis]. Anaesthesist 2009; 58:602-6. [PMID: 19562397 DOI: 10.1007/s00101-009-1558-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute lymphoblastic leukaemia is the most common malignancy in childhood. This disease and its associated therapy may lead to specific life-threatening complications if general anaesthesia has to be carried out. The case of a 14-year-old boy suffering from aspergillosis because of immunosuppression in the course of chemotherapy is reported. Due to a cerebral round lesion an open biopsy was required. After induction of anaesthesia, severe pulmonary obstruction developed. After exchange of the endotracheal tube a coagulum-like foreign body interspersed with Aspergillus hyphae obstructing the distal aperture in a valve-like manner could be recovered. The resulting unilateral tension pneumothorax had to be relieved with a closed pleural drainage. With reference to this as yet unreported life-threatening complication of pulmonary aspergillosis, the appropriate preparation and conduction of general anaesthesia are discussed.
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Affiliation(s)
- C Söllmann
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinik Würzburg, Würzburg, Deutschland.
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Lionakis MS, Samonis G, Kontoyiannis DP. Endocrine and metabolic manifestations of invasive fungal infections and systemic antifungal treatment. Mayo Clin Proc 2008; 83:1046-60. [PMID: 18775205 DOI: 10.4065/83.9.1046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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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Affiliation(s)
- Michail S Lionakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
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Al-Haddad M, Pungpapong S, Wallace MB, Raimondo M, Woodward TA. Antegrade and retrograde endoscopic approach in the establishment of a neo-esophagus: a novel technique. Gastrointest Endosc 2007; 65:290-4. [PMID: 17258990 DOI: 10.1016/j.gie.2006.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 08/07/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although total obstruction or secondary atresia of the esophagus is extremely rare, high-grade strictures are not uncommon. The retrograde approach was previously described to achieve dilation when the conventional antegrade method fails. SETTING Gastroenterology laboratory in a tertiary referral center. PATIENT A 30-year-old man with congenital T-cell immunodeficiency had complete esophageal obstruction after a severe episode of cryptococcal meningitis that required prolonged nasogastric intubation. For the next 3 years, he had daily episodes of regurgitations and several hospitalizations for aspiration pneumonia. A barium study revealed a dilated megaesophagus, with no contrast reaching to the stomach. INTERVENTION Initially, a new track was created by using access from above and below the obstruction. This was followed by placement of a self-expandable silicone stent after allowing sufficient time for the new track to mature. MAIN OUTCOME MEASUREMENTS Restoration of esophageal continuity, which allowed resolution of the patient's aspiration pneumonia and resumption of oral feeding. CONCLUSIONS Complete esophageal obstruction after prolonged nasogastric intubation is a rare but serious complication. A novel endoscopic approach can be used to restore esophageal continuity, minimize complications, and avoid major reconstructive surgeries.
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Affiliation(s)
- Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.
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Guetgemann A, Brandenburg VM, Ketteler M, Riehl J, Floege J. Unclear fever 7 weeks after renal transplantation in a 56-year-old patient. Nephrol Dial Transplant 2006; 21:2325-7. [PMID: 16751654 DOI: 10.1093/ndt/gfl280] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anne Guetgemann
- Department of Nephrology and Clinical Immunology, University Hospital Aachen Pauwelsstrasse 30, D-52057 Aachen, Germany
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Goldani LZ, Zavascki AP, Maia AL. Fungal Thyroiditis: An Overview. Mycopathologia 2006; 161:129-39. [PMID: 16482384 DOI: 10.1007/s11046-005-0239-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 11/24/2005] [Indexed: 11/27/2022]
Abstract
The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.
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Affiliation(s)
- Luciano Z Goldani
- Section of Infectious Diseases, Universidade Federal do Rio Grande do Sul, Brazil.
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Sion ML, Armenaka MC, Georgiadis I, Paraskevopoulos G, Nikolaidis I. Aspergillus fumigatus abscesses of the thyroid with obstruction of the esophagus. Thyroid 2004; 14:786-8. [PMID: 15361267 DOI: 10.1089/thy.2004.14.786] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Thyroid invasion by Aspergillus spp. can occur with invasive aspergillosis, although it is rarely diagnosed antemortem. We describe a case of multiple thyroid abscesses from A. fumigatus that caused esophageal obstruction in a patient with myelodysplasia. Despite aggressive antifungal treatment, the outcome was rapidly fatal.
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Affiliation(s)
- Michael L Sion
- Third Department of Internal Medicine, General Hospital G. Papanikolaou, School of Medicine, Aristotelian University of Thessaloniki, Thessaloniki, Greece.
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