Aspergillus Thyroiditis: A Complication of Respiratory Tract Infection in an Immunocompromised Patient

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. 1. Introduction Aspergillus thyroiditis (AT) remains the most commonly reported fungal thyroiditis, followed by Candida species [1]. It has primarily been a postmortem diagnosis in immune-compromised patients [2–4]. The diagnostic strategy in such patients remains a challenge. Fine needle aspiration (FNA) with subsequent cytology and culture remains the recommended, most frequent and most successful method used to diagnose AT [5, 6]. However, the utility of subjecting patients to invasive procedure such as FNA in the setting of critical illness remains unclear. 2. Case Presentation The patient is a 59-year-old male with past medical history significant for non-Hodgkin’s lymphoma (NHL) (Stage IV Splenic Marginal Zone) and transfusion-dependent myelodysplasia. The patient was diagnosed with NHL seven years prior to presentation. NHL management included failed resection of spleen, inadequate response to rituximab, and eventual complete response to six cycles of fludarabine. The patient developed persistent pancytopenia and multilineage dysplasia. One year prior to presentation, the patient was admitted for disseminated herpes zoster infection (CN V1, ophthalmic involvement, and wrist/knee vesicles). One month prior to presentation, the patient tolerated a short course of