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Suppurative thyroiditis due to aspergillosis: a case report
Suemi Marui1, Ariella Cabral de Lima Pereira, Raquel Maria de Araújo Maia
1Unidade de Tireoide-Disciplina de Endocrinologia e Metabologia, Avenida Dr Arnaldo 455 Sala 4305, 01246-903 Sao Paulo, SP, Brazil. suemimar@usp.br.
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.
Insights
Aspergillus fumigatus can cause severe thyroiditis in immunocompromised patients, often leading to disseminated infection and high mortality. Early diagnosis and prompt treatment with antifungals like voriconazole are crucial for better outcomes.
Area of Science:
- Mycology
- Endocrinology
- Infectious Diseases
Background:
- Aspergillus is a common nosocomial fungal agent causing suppurative thyroiditis.
- Disseminated infection, often with lung compromise, is typical in Aspergillus thyroiditis.
- High mortality rates are linked to delayed diagnosis, severe immunosuppression, and thyroid hormone overload.
Observation:
- A 20-year-old man with systemic lupus erythematosus on corticosteroids presented with fever, neck pain, and pulmonary infection.
- He developed hypoxemia, shock, anemia, and lymphopenia despite broad-spectrum antibiotics.
- Thyroid ultrasound showed hypoechogenic clusters, and fine needle aspiration yielded purulent material.
Findings:
- The patient exhibited laboratory signs of thyrotoxicosis with low triiodothyronine.
- Despite antifungal treatment (amphotericin B, fluconazole), his condition worsened, leading to death.
- Aspergillus fumigatus was identified post-mortem, highlighting diagnostic challenges.
Implications:
- This case underscores the importance of considering infectious thyroiditis, particularly aspergillosis, in immunocompromised individuals.
- Prompt diagnosis and management, potentially including voriconazole or amphotericin B alongside antibiotics, are vital for improving survival.
- Clinicians should maintain a high index of suspicion for invasive fungal infections in at-risk populations.
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