Coccidioidomycosis of the thyroid.

Area of Science:

• Mycology
• Endocrinology
• Infectious Diseases

Background:

• Coccidioidomycosis is a fungal infection endemic to the southwestern United States.
• Thyroiditis is inflammation of the thyroid gland, often presenting with symptoms similar to other thyroid conditions.
• While Coccidioides immitis typically affects the lungs, disseminated disease can involve other organs.

Observation:

• Two patients presented with thyroid symptoms and clinical findings consistent with subacute thyroiditis.
• Diagnostic investigations revealed thyroiditis caused by the fungal pathogen Coccidioides immitis.
• This presentation represents a novel manifestation of coccidioidomycosis.

Findings:

• Fine needle aspiration biopsy of the thyroid was instrumental in identifying Coccidioides immitis.
• The thyroiditis observed in these cases mimicked the clinical and sonographic features of subacute thyroiditis.
• Microscopic examination confirmed the presence of fungal elements consistent with Coccidioides immitis.

Implications:

• This case series highlights the importance of considering fungal infections in the differential diagnosis of thyroiditis, particularly in endemic areas.
• Fine needle aspiration biopsy is a valuable tool for diagnosing thyroidal coccidioidomycosis.
• Early and accurate diagnosis is essential for appropriate management and to prevent potential complications of disseminated fungal infections.