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Polster N, Yocum BP, Lavik JP, Mesa H. Painful Granulomatous Hashimoto Thyroiditis Uncovered Systemic Histoplasmosis. Int J Surg Pathol 2024; 32:615-618. [PMID: 37461236 DOI: 10.1177/10668969231186928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background. Granulomatous thyroiditis is usually viral and very rarely due to fungal infection. Fungal thyroiditis affects the severely immunocompromised and only rarely immunocompetent individuals. Case report. A 32-year-old man with known Hashimoto thyroiditis was consulted for a 1-week history of neck pain, dysphagia, cough, asthenia, loss of appetite, and night sweats. Imaging showed an enlarged right thyroid lobe. Laboratory studies confirmed hypothyroidism. He underwent a thyroid lobectomy. Microscopic examination showed granulomas in a background of Hashimoto thyroiditis. Silver stain revealed numerous yeasts consistent with Histoplasma. Subsequent serology was also positive. Further evaluations were negative for acquired or constitutional immunodeficiencies. He was started on oral itraconazole with resolution of all constitutional symptoms. Conclusions. We report a second case of concurrent Hashimoto and Histoplasma thyroiditis in an immunocompetent patient. Systemic manifestations of fungal infection are confounded by systemic symptoms of thyroid dysfunction. Fungal thyroiditis is a manifestation of systemic fungal infection requiring prolonged systemic therapy to prevent complications or fatal outcomes.
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Affiliation(s)
- Nicholas Polster
- Department of Laboratory Medicine & Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bianca Puello Yocum
- Department of Laboratory Medicine & Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John-Paul Lavik
- Department of Laboratory Medicine & Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hector Mesa
- Department of Laboratory Medicine & Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
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2
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Uccella S, Dottermusch M, Erickson L, Warmbier J, Montone K, Saeger W. Inflammatory and Infectious Disorders in Endocrine Pathology. Endocr Pathol 2023; 34:406-436. [PMID: 37209390 PMCID: PMC10199304 DOI: 10.1007/s12022-023-09771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
A variety of inflammatory conditions may directly involve the endocrine glands, leading to endocrine dysfunction that can cause severe consequences on patients' health, if left untreated. Inflammation of the endocrine system may be caused by either infectious agents or other mechanisms, including autoimmune and other immune-mediated processes. Not infrequently, inflammatory and infectious diseases may appear as tumor-like lesions of endocrine organs and simulate neoplastic processes. These diseases may be clinically under-recognized and not infrequently the diagnosis is suggested on pathological samples. Thus, the pathologist should be aware of the basic principles of their pathogenesis, as well as of their morphological features, clinicopathological correlates, and differential diagnosis. Interestingly, several systemic inflammatory conditions show a peculiar tropism to the endocrine system as a whole. In turn, organ-specific inflammatory disorders are observed in endocrine glands. This review will focus on the morphological aspects and clinicopathological features of infectious diseases, autoimmune disorders, drug-induced inflammatory reactions, IgG4-related disease, and other inflammatory disorders involving the endocrine system. A mixed entity-based and organ-based approach will be used, with the aim to provide the practicing pathologist with a comprehensive and practical guide to the diagnosis of infectious and inflammatory disorders of the endocrine system.
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Affiliation(s)
- Silvia Uccella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanule, Milan, Italy
- Pathology Service IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Matthias Dottermusch
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lori Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Julia Warmbier
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Wolfgang Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Solis-Pazmino P, Merchant N, Padilla O, Alkhalili E. Coccidioidomycosis masquerading as thyroid nodule: a rare diagnostic challenge. J Surg Case Rep 2023; 2023:rjad359. [PMID: 37360743 PMCID: PMC10284675 DOI: 10.1093/jscr/rjad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
We present a compelling case of disseminated coccidioidomycosis involving the thyroid gland, a remarkably uncommon manifestation of this infection. The gravity of this sporadic disease is underscored by its high mortality rate, primarily because of challenges in timely diagnosis and treatment initiation. Accurate diagnosis hinges upon utilizing various techniques, including the culture of a fine-needle aspirate, biopsy and direct microscopy. However, the medical community is still grappling with the optimal treatment strategy, encompassing considerations such as duration and dosage of medications, which continue to be subjects of intense controversy and ongoing research. This article aims to report an older patient with the incidental diagnosis and management of Coccidioides in the thyroid.
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Affiliation(s)
- Paola Solis-Pazmino
- Correspondence address. Duque de Caxias 1667, Porto Alegre, Brazil. Tel: 51993505527; E-mail:
| | - Natalie Merchant
- Surgery Department, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Osvaldo Padilla
- Surgery Department, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Eyas Alkhalili
- Surgery Department, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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4
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Raza N, Heidari A. A Case of Thyroidal Coccidioidal Infection. J Investig Med High Impact Case Rep 2022; 10:23247096221090840. [PMID: 35426317 PMCID: PMC9016518 DOI: 10.1177/23247096221090840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infection of the thyroid gland with Coccidioides immitis is rare. We report a case with disseminated coccidiomycosis involving thyroid gland as a thyroid nodule. Although historical autopsy studies have indicated that coccidioidal involvement of the thyroid gland can infrequently occur as part of disseminated infection, to our knowledge, only less than 10 other cases have been reported. Optimal treatment duration and dosage of medication are uncertain in literature of this rare involvement of thyroid gland with coccidioidomycosis.
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Affiliation(s)
- Nadia Raza
- Kern Medical, Bakersfield, CA, USA
- Nadia Raza, MD, Department of Medicine, Kern
Medical, 1700 Mount Vernon, Bakersfield, CA 93306, USA.
| | - Arash Heidari
- Kern Medical, Bakersfield, CA, USA
- Valley Fever Institute, Bakersfield, CA,
USA
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5
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Niles D, Boguniewicz J, Shakeel O, Margolin J, Chelius D, Gupta M, Paul D, King KY, McNeil JC. Candida tropicalis Thyroiditis Presenting With Thyroid Storm in a Pediatric Patient With Acute Lymphocytic Leukemia. Pediatr Infect Dis J 2019; 38:1051-3. [PMID: 31365478 DOI: 10.1097/INF.0000000000002424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Suppurative thyroiditis is uncommon in the pediatric population and particularly rare to be caused by fungi. We present a case of Candida tropicalis thyroiditis in an adolescent male with acute lymphocytic leukemia that led to disseminated candidiasis, thyroid storm and eventual total thyroidectomy for source control.
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6
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Phulware RH, Gupta B, Sahoo B, Agarwal S, Mathur S. Aspergillus thyroiditis: In an immunocompromised young adult. Diagn Cytopathol 2018; 47:362-364. [PMID: 30499196 DOI: 10.1002/dc.24084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Biswajit Sahoo
- All india institute of medical sciences, New Delhi, India
| | - Shipra Agarwal
- All india institute of medical sciences, New Delhi, India
| | - Sandeep Mathur
- All india institute of medical sciences, New Delhi, India
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7
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Affiliation(s)
- Christopher King
- Advanced Lung Disease and Lung Transplantation, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Stephen Clement
- Advanced Lung Disease and Lung Transplantation, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Shalika Katugaha
- Advanced Lung Disease and Lung Transplantation, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Anne Whitney Brown
- Advanced Lung Disease and Lung Transplantation, Inova Fairfax Hospital, Falls Church, Virginia, USA
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Rao N, Mann SJ. Fine needle aspiration cytology of acute blastomycosis thyroiditis. Diagn Cytopathol 2017; 45:1119-1121. [PMID: 28792123 DOI: 10.1002/dc.23795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Nagarjun Rao
- Department of Pathology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Sherri J Mann
- Department of Pathology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
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10
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Nicolè S, Lanzafame M, Cazzadori A, Vincenzi M, Mangani F, Colato C, El Dalati G, Brazzarola P, Concia E. Successful Antifungal Combination Therapy and Surgical Approach for Aspergillus fumigatus Suppurative Thyroiditis Associated with Thyrotoxicosis and Review of Published Reports. Mycopathologia 2017; 182:839-845. [PMID: 28555254 DOI: 10.1007/s11046-017-0145-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
In immunocompromised patients, Aspergillus infections are important causes of morbidity and mortality. We describe a patient with cryoglobulinemic vasculitis who developed disseminated invasive aspergillosis with thyrotoxicosis caused by Aspergillus fumigatus. The diagnosis was based upon radiological, microbiological and pathological findings. The patient was treated successfully with voriconazole and caspofungin treatment followed by total thyroidectomy. We provide an overview of published reports on Aspergillus thyroiditis with an emphasis on therapeutic approaches.
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Affiliation(s)
- S Nicolè
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy.
| | - M Lanzafame
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - A Cazzadori
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - M Vincenzi
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - F Mangani
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - C Colato
- Department of Pathology, "G. B. Rossi" University Hospital, Verona, Italy
| | - G El Dalati
- Department of Radiology, "G. B. Rossi" University Hospital, Verona, Italy
| | - P Brazzarola
- Department of General Surgery and Pancreatic Surgery, "G. B. Rossi" University Hospital, Verona, Italy
| | - E Concia
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
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11
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Ataca P, Atilla E, Saracoglu P, Yilmaz G, Civriz Bozdag S, Toprak SK, Yuksel MK, Ceyhan K, Topcuoglu P. Aspergillus Thyroiditis after Allogeneic Hematopoietic Stem Cell Transplantation. Case Rep Hematol 2015; 2015:537187. [PMID: 26640727 DOI: 10.1155/2015/537187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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12
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Affiliation(s)
- Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jae Ho Lee
- Division of Nephrology, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Yejee Lim
- Division of Nephrology, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Hae Kyung Yang
- Division of Nephrology, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Yoon Sik Chang
- Division of Nephrology, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
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13
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Marui S, de Lima Pereira AC, de Araújo Maia RM, Borba EF. Suppurative thyroiditis due to aspergillosis: a case report. J Med Case Rep 2014; 8:379. [PMID: 25412755 PMCID: PMC4275757 DOI: 10.1186/1752-1947-8-379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/15/2014] [Indexed: 03/16/2023] Open
Abstract
Introduction Aspergillus, a nosocomial agent, is the most common fungal cause of suppurative thyroiditis. Most patients with Aspergillus thyroiditis have disseminated infection, primarily with lung compromise. Late diagnosis and treatment, severity of immunosuppressive state and thyroid hormone overload contribute to extremely high mortality rates. Case presentation We describe a 20-year-old Caucasian man receiving corticosteroid suppression therapy for systemic lupus erythematosus. He presented persistent fever with neck pain and pulmonary infection. Piperacillin/tazobactam was initiated but after 2 days he developed hypoxemia, vascular shock, severe anemia, lymphopenia, and high C-reactive protein. Thyroid ultrasound revealed well-defined hypoechogenic clusters in both lobes and laboratorial thyrotoxicosis but low triiodothyronine concentration. A purulent substance was obtained on fine needle aspiration and drained. Amphotericin B and fluconazole were added but he had unfavorable evolution and died. Aspergillus fumigatus was defined only 2 days after his death. Conclusions This case serves to alert clinicians to the possibility of infectious thyroiditis and reinforces the high risk of aspergillosis in immunocompromised patients. Therefore, management including voriconazole as first-line treatment or amphotericin B, in association with broad-spectrum antibiotic therapy, should be adopted to improve treatment outcome.
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Affiliation(s)
- Suemi Marui
- Unidade de Tireoide-Disciplina de Endocrinologia e Metabologia, Avenida Dr Arnaldo 455 Sala 4305, 01246-903 Sao Paulo, SP, Brazil.
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Massolt ET, Rijneveld AW, Vernooij MW, Kevenaar ME, van Kemenade FJ, Peeters RP. Acute Candida thyroiditis complicated by abscess formation in a severely immunocompromised patient. J Clin Endocrinol Metab 2014; 99:3952-3. [PMID: 25033071 DOI: 10.1210/jc.2014-2528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Elske T Massolt
- Division of Endocrinology (E.T.M., R.P.P.); Rotterdam Thyroid Center, Department of Internal Medicine (E.T.M., R.P.P.); Division of Hematology, Department of Internal Medicine (A.W.R.); and Departments of Epidemiology and Radiology (M.W.V.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Internal Medicine (M.E.K.), Vlietland Hospital, 3100 AE Schiedam, The Netherlands; and Department of Pathology (F.J.v.K.), Erasmus MC, 3000 CA Rotterdam, The Netherlands
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15
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Abstract
CONTEXT Acute infectious thyroiditis, particularly fungal thyroiditis, is rare and typically presents in immunocompromised individuals. Here we report the first case of coccidiomycosis thyroiditis occurring in an organ recipient as a consequence of likely allograft contamination and discuss the management strategies for thyroid masses in the setting of disseminated infection. EVIDENCE ACQUISITION AND SYNTHESIS In this clinical case seminar, we summarize the previously published cases of coccidiomycosis thyroiditis based on a MEDLINE search of all peer-reviewed publications (original articles and reviews) on this topic. We identified six other cases, five of which also occurred in immunocompromised hosts, although none occurred in organ recipients. CONCLUSION A case of coccidiomycosis thyroiditis occurring in a post-liver transplant immunocompromised host is reported. Analysis of donor serum revealed the liver allograft as the likely infectious source, resulting in hematological spread to the thyroid. Although our patient's thyroid gland was lacking gross structural abnormalities at presentation, new-onset thyroid masses developed after relative immune restoration and initiation of antifungal therapies. The differential diagnosis of new-onset thyroid masses in immunocompromised hosts is discussed, with a focus on immune reconstitution inflammatory syndrome. The role of thyroidectomy in the management of fungal thyroiditis is also discussed.
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Affiliation(s)
- Elizabeth A McAninch
- Division of Endocrinology, Diabetes, and Metabolism, University of Miami, Miami, Florida 33136
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16
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Cherqaoui R, Shakir KM, Shokrani B, Madduri S, Farhat F, Mody V. Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients. J Thyroid Res 2014; 2014:364146. [PMID: 24587936 DOI: 10.1155/2014/364146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 11/29/2022] Open
Abstract
Objective. To study histopathology of the thyroid and parathyroid glands in HIV-infected African Americans in the United States.
Methods. A retrospective review of 102 autopsy cases done by the Department of Pathology at Howard University Hospital from 1980 through 2007 was conducted. The histopathological findings of the thyroid and parathyroid glands were reviewed, both macroscopically and microscopically. A control group of autopsy patients with chronic non-HIV diseases was examined. Results. There were 71 males (70%) and 31 females (30%) with an average age of 38 years (range: 20–71 y). Thirteen patients with abnormal thyroid findings were identified. Interstitial fibrosis was the most common histological finding (4.9%), followed by thyroid hyperplasia (1.9%). Infectious disease affecting the thyroid gland was limited to 2.9% and consisted of mycobacterium tuberculosis, Cryptococcus neoformans, and cytomegalovirus. Kaposi sarcoma of the thyroid gland was present in only one case (0.9%). Parathyroid hyperplasia was the most common histological change noted in the parathyroid glands. Comparing the histological findings of cases and controls, we found a similar involvement of the thyroid, with a greater prevalence of parathyroid hyperplasia in HIV patients. Conclusion. Thyroid and parathyroid abnormalities are uncommon findings in the HIV-infected African American population.
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Alvi MM, Meyer DS, Hardin NJ, Dekay JG, Marney AM, Gilbert MP. Aspergillus thyroiditis: a complication of respiratory tract infection in an immunocompromised patient. Case Rep Endocrinol 2013; 2013:741041. [PMID: 24455333 DOI: 10.1155/2013/741041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
A 59-year-old male with past medical history significant for non-Hodgkin's lymphoma status after chemotherapy presented with acute onset of neck pain, odynophagia, and dysphagia associated with subjective fever, chills, and dyspnea. Physical findings included a temperature of 38.4°C, hypertension, and tachycardia. Patient was found to have anterior neck tenderness. Laboratory evaluation revealed neutropenia. The patient was started on empiric antibacterial and antiviral therapy and continued on home prophylactic antifungal treatment. Thyroid function tests revealed overt hyperthyroidism. A thyroid ultrasound showed heterogeneous echotexture without discrete nodules. Subacute thyroiditis was treated with methylprednisolone, metoprolol, and opiate analgesics. Patient's antibacterial, antifungal, and antiviral treatments were broadened. A fine needle aspiration was not conducted. The patient's condition deteriorated rapidly over his brief hospital course and he expired. Autopsy showed fungal thyroiditis secondary to disseminated invasive Aspergillus. This report describes the presentation of fungal thyroiditis secondary to disseminated invasive Aspergillus originating from the respiratory tract. The authors review the diagnostic challenges, pathophysiology, and treatment of this condition.
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Izzi-Engbeaya C, Zac-Varghese S, Palazzo F, Sanderson F, Meeran K, Dhillo WS. A young fit man presenting to the emergency department with a painful neck due to a thyroid abscess. QJM 2013; 106:1041-2. [PMID: 23824940 DOI: 10.1093/qjmed/hct144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Izzi-Engbeaya
- Section of Investigative Medicine, Imperial College London, 6th Floor, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK.
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19
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Thada ND, Prasad SC, Alva B, Pokharel M, Prasad KC. A rare case of suppurative aspergillosis of the thyroid. Case Rep Otolaryngol 2013; 2013:956236. [PMID: 24159398 DOI: 10.1155/2013/956236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
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 4 × 4 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.
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Santiago M, Martinez JH, Palermo C, Figueroa C, Torres O, Trinidad R, Gonzalez E, Miranda Mde L, Garcia M, Villamarzo G. Rapidly growing thyroid mass in an immunocompromised young male adult. Case Rep Endocrinol 2013; 2013:290843. [PMID: 23936688 DOI: 10.1155/2013/290843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Irga N, Kosiak W, Jaworski R, Komarnicka J, Birkholz D. Hyperthyroidism secondary to disseminated mucormycosis in a child with acute lymphoblastic leukemia: case report and a review of published reports. Mycopathologia 2012; 175:123-7. [PMID: 23007613 PMCID: PMC3550700 DOI: 10.1007/s11046-012-9584-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 09/14/2012] [Indexed: 11/29/2022]
Abstract
Thyroiditis due to fungal infection is an extremely rare cause of hyperthyroidism. The most common etiological factor of thyroiditis is Aspergillus. Infections due to members of the Mucorales have been an increasing clinical problem in recent years, and the prognosis in generalized infections due to those fungi is usually very poor. No hyperthyroidism in a child with thyroiditis due to mucormycosis has been reported in the literature so far. We describe a clinical course of generalized mucormycosis with thyroid involvement in a 12-year-old girl treated for acute lymphoblastic leukemia. The child underwent a hyperthyroidism connected with thyroid involvement due to a fungal process. The diagnosis was based on the clinical signs, laboratory findings and typical ultrasound scan; however, later attempt to amplify the fungi DNA from the tissue block has failed. The child died because of multiorgan failure due to general fungal infection 49 days after the invasive fungal infection was diagnosed. The generalized mucormycosis is always connected with poor prognosis and the mortality is high.
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Affiliation(s)
- Ninela Irga
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Debinki 7, 80-211, Gdansk, Poland.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
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Abstract
We report a case of Coccidioides thyroiditis in an HIV-infected patient with a history of recent Coccidioides pneumonia but with negative Coccidioides serology determined by enzyme immunoassay at presentation. Diagnosis of Coccidioides thyroiditis was made based on histopathologic examination and culture of thyroid abscess material obtained by fine-needle aspiration biopsy.
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Harvey AM, Mody DR, Amrikachi M. Disseminated blastomycosis diagnosed by fine-needle aspiration of the thyroid. Diagn Cytopathol 2010; 39:446-50. [DOI: 10.1002/dc.21466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 05/04/2010] [Indexed: 11/07/2022]
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Mayayo E, Klock C, Goldani L. Thyroid involvement in disseminated zygomycosis by Cunninghamella bertholletiae: 2 cases and literature review. Int J Surg Pathol 2009; 19:75-9. [PMID: 19168908 DOI: 10.1177/1066896908329595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thyroid involvement is very rare in disseminated zygomycosis. We describe two cases of thyroiditis due to Cunninghamella bertholletiae diagnosed though a necropsy study and the only five previous cases of thyroid zygomycosis reported in the literature are revised.
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Affiliation(s)
- Emilio Mayayo
- Sección de Patología Infecciosa, Servicio de Patología, Hospital Universitario Juan XX, Tarragona, Spain.
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Zwitserloot AM, Warris A, van't Hek LG, van Die LE, Verweij PE, Mavinkurve-Groothuis AMC. Disseminated aspergillosis in an adolescent with acute lymphoblastic leukemia. Pediatr Blood Cancer 2008; 51:423-6. [PMID: 18478572 DOI: 10.1002/pbc.21601] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disseminated aspergillosis in immunocompromised patients has a mortality rate of almost 100%. Despite the development of new antifungal agents, the outcome of disseminated aspergillosis has only improved slightly, particular in patients with central nervous system (CNS) involvement. The use of combination antifungal therapy might improve the dismal outcome of disseminated aspergillosis. We describe a critically ill adolescent with acute lymphoblastic leukemia who was successfully treated with voriconazole and caspofungin for disseminated aspergillosis with involvement of the lung, brain and thyroid gland.
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Affiliation(s)
- Annelies M Zwitserloot
- Department of Pediatric Hematology and Oncology, Radboud University Nijmegen Medical Centre, The Netherlands
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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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28
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Abstract
Neck masses are common and have a variety of infectious agents and noninfectious causes. This article reviews the more common infectious causes of neck masses-cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Important clinical pearls, diagnostic evaluation including laboratory studies, and imaging are summarized. Methods for prevention are highlighted.
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Affiliation(s)
- Nawaf Al-Dajani
- Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street, University of British Columbia, Vancouver, BC V6H 3N1, Canada
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