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 ？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. 1. Introduction Thyroiditis by fungal organisms is infrequent. Most cases have been reported on immunocompromised patients, such as those with organ transplant, leukemias, receiving certain types of chemotherapy, subjects with human immunodeficiency virus, and others types of immunosuppression. This uncommon site of infections could be explained by the unique features of the thyroid gland [1], that includes protective mechanisms, such as rich blood supply, separation of the neck by fascial planes, high iodine content, and a fibrous capsule [2]. Among the different types of fungal thyroiditis, Aspergillus spp. are the predominant causative fungus for thyroiditis and asymptomatic thyroid infiltration [2–4]. Aspergillus thyroiditis (AT) has primarily been a postmortem diagnosis on immunocompromised patients with diagnosed disseminated invasive Aspergillosis (DIA) [5, 6]. Reports of antemortem diagnosis are rare, and for this reason in the literature it is difficult to find reports of surviving patients. Here, we report a case describing AT, in an immunocompromised young adult male with a rapidly growing thyroid mass; diagnosis was able to be performed antemortem by FNA cytology. We also review the epidemiology, clinical manifestations, diagnosis, and outcome of the different AT cases reported in the medical literature published during the years 1980–2012 through a search of the PubMed database. 2. Case A 20-year-old man was admitted to our hospital on July 2012. He was diagnosed as having an MDS one month before; by that moment he had received two courses of chemotherapy consisting of azacitidine. Admission to the hospital was due to pancytopenia and fever of
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