ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P806

A rare clinical picture: thyroid cystic nodule as a localization of Aspergillus pulmonary infection (pulmonary-thyroid form)

Pierluigi De Remigis1, Lorenzo Di Liberato2, Eligio Pizzigallo3, Alessandra De Remigis1, Walter Bisello2, Francesco Emma4, Marina Vivarelli4 & Luigi Vianale1

1Endocrine Unit of General Hospital, Chieti, Italy; 2Nefrologic Clinic of University, Chieti, Italy; 3Infective Clinic of University, Chieti, Italy; 4Children Hospital ‘Bambino Gesù’, Rome, Italy.

Aspergillus infection (A)is often recognized in severely immunocompromised patients.

Although involvement of the thyroid gland is reported for 9–15% of patients with disseminated disease, a localized clinical picture it’s not reported.

Here, we present a case of Aspergillus in a LES young patient (15-year-old girl), who underwent to a strong immunosuppressive regimen (high doses of corticosteroids, endoxan and plasmaferesis). After about one month she developed pulmonary A. Chest CAT revealed signs of A infection (interstitial and cavernous form). Routine respiratory cultures repeatedly grew A. flavus.

The galactomannan enzyme-linked immunosorbent assay, one of the most sensitive test available for aspergillosis diagnosis, had a positive result.

Laboratory tests performed before A development, in order to test autoimmune associated diseases, showed TSH mild elevated (8.5 mUi/ml), normal FT3 (2.38 pg/ml) and FT4 (1.07 ng/dl) AbTg (3.7 UI/ml) AbTPO (33 UI/ml), suggesting a form of autoimmune thyroiditis.

She was treated with L-T4. When A has arisen, at physical examination of the neck a small nodule was appreciated.

An anecoic imagine was shown by ultrasound, no colour signs at ecocolor-doppler A FNA was made and septate hyphae, consistent with Aspergillus species, were identified in Periodic acid-Schiff stain cytology.

The patient was put in antifungeal therapy and the thyroid nodule was monitored.

The A. pulmonary picture remitted, while the thyroid cyst is still evident at ecography, presenting the same size and ecostructure, and at FNA positive Periodic acid-Schiff stain cytology for hyphae.

The involvement of thyroid by A is frequent, mostly in the context of a A diffusive form. This is characterized by a destructive form of thyroiditis.

A localized form as a thyroid cystic nodule, like we described here, associated to pulmonary A (pulmonary-thyroid form) is unusual. It’s interesting it seems to show a some resistance to antifungeal therapy.

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