Abstract
Aspergillus involvement of the thyroid is the most commonly reported fungal thyroiditis. Aspergillus thyroiditis (AT) has primarily been a postmortem diagnosis in immunocompromised patients with diagnosed disseminated invasive Aspergillus or high suspicion of fungal infection during life. With better treatment modalities for the comorbidities that place patients at high risk for fungal infections, as well as better antifungal therapies for Aspergillus infections specifically, the spectrum of disease and presentation of AT may be shifting from what was primarily a postmortem finding to an antemortem diagnosis, necessitating a high index of clinical suspicion and timely intervention. We present a review of the literature to better clarify clinical features, diagnostic modalities, and management considerations pertaining to this disease.
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References
Grekin RH, Cawley EP, Zheutlin B (1950) Generalized aspergillosis. Report of a case. Arch Path 49:387–392
Meyer RD, Young LS, Armstrong D, Yu B (1973) Aspergillosis complicating neoplastic disease. Am J Med 54:6–15
Vogeser M, Haas A, Aust D, Ruckdeschel G (1997) Postmortem analysis of invasive aspergillosis in a tertiary care hospital. Eur J Clin Microbiol Infect Dis 16:1–6
Goldani LZ, Zavascki AP, Maia AL (2006) Fungal thyroiditis: an overview. Mycopathologia 161:129–139
Young RC, Bennett JE, Vogel CL, Carbone PP, DeVita VT (1970) Aspergillosis. The spectrum of the disease in 98 patients. Medicine (Baltimore) 49:147–173
Abe F, Tateyama M, Shibuya H, Azumi N, Ommura Y (1984) Disseminated fungal infection. A review of 20 autopsy cases. Acta Pathol Jpn 34(6):1201–1208
Boon AP, O’Brien D, Adams DH (1991) 10 year review of invasive aspergillosis detected at necropsy. J Clin Pathol 44:452–454
Denning DW, Stevens DA (1990) Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases. Rev Infect Dis 12:1147–1201
Winzelberg GG, Gore J, Yu D, Vagenakis AG, Braverman LE (1979) Aspergillus flavus as a cause of thyroiditis in an immunosuppressed host. Johns Hopkins Med J 144(3):90–93
Murray HW, Moore JO, Luff RD (1975) Disseminated aspergillosis in a renal transplant patient: diagnostic difficulties re-emphasized. Johns Hopkins Med J 137(5):235–237
Buła G, Trompeta J, Niemiec A, Truchanowski W, Gawrychowski J (2009) Purulent thyroiditis—a clinical study of 5 cases. Acta Chir Belg 109(5):617–619
Cornet M, Ugo V, Lefort E, Molina T, James JM, Vekhoff A, Audouin J, Marie JP, Bouvet A (2001) A case of disseminated aspergillosis with thyroid involvement. Eur J Clin Microbiol Infect Dis 20:358–359
Luke JL, Bolande RP, Gross S (1963) Generalized aspergillosis and Aspergillus endocarditis in infancy. Pediatrics 1:115–122
Allen GW, Andersen DH (1960) Generalized aspergillosis in an infant 18 days of age. Pediatrics 26:432–440
Halazun JF, Anast CS, Lukens JN (1972) Thyrotoxicosis associated with Aspergillus thyroiditis in chronic granulomatous disease. J Pediatr 80(1):106–108
Lisbona R, Lacourciere Y, Rosenthall L (1973) Aspergillomatous abscesses of the brain and thyroid. J Nucl Med 14:541–542
Solary E, Rifle G, Chalopin JM, Rifle-Mediavilla C, Rebibou JM, Camerlynck P, Justrabo E, Cuisenier B, Caillot D, Mousson C, Tanter Y (1987) Disseminated aspergillosis revealed by thyroiditis in a renal allograft recipient. Transplantation 44:839–840
Vogeser M, Haas A, Ruckdeschel G, von Scheidt W (1998) Steroid-induced invasive aspergillosis with thyroid gland abscess and positive blood cultures. Eur J Clin Microbiol Infect Dis 17:215–216
Torres AM, Agrawal S, Peters S, Khurana K, Feiglin D, Schroeder E, Izquierdo R (1999) Invasive aspergillosis diagnosed by fine-needle aspiration of the thyroid gland. Thyroid 9(11):1119–1122
Hornef MW, Schopohl J, Zietz C, Hallfeldt KK, Roggenkamp A, Gärtner R, Heesemann J (2000) Thyrotoxicosis induced by thyroid involvement of disseminated Aspergillus fumigatus infection. J Clin Microbiol 38:886–887
Ayala AR, Basaria S, Roberts KE, Cooper DS (2001) Aspergillus thyroiditis. Postgrad Med J 77:336
Jang KS, Han HX, Oh YH, Paik SS (2004) Aspergillosis of the thyroid gland diagnosed by fine needle aspiration cytology. Acta Cytol 48(6):875–876
Sion ML, Armenaka MC, Georgiadis I, Paraskevopoulos G, Nikolaidis I (2004) Aspergillus fumigatus abscesses of the thyroid with obstruction of the esophagus. Thyroid 14(9):786–788
Elzi L, Laifer G, Bremerich J, Vosbeck J, Mayr M (2005) Invasive aspergillosis with myocardial involvement after kidney transplantation. Nephrol Dial Transplant 20(3):631–634
Matsui Y, Sugawara Y, Tsukada K, Kishi Y, Shibahara J, Makuuchi M (2006) Aspergillus thyroiditis in a living donor liver transplant recipient. J Infect 53:e231–e233
Guetgemann A, Brandenburg VM, Ketteler M, Riehl J, Floege J (2006) Unclear fever 7 weeks after renal transplantation in a 56-year-old patient. Nephrol Dial Transplant 21(8):2325–2327
Zwitserloot AM, Warris A, van’t Hek LG, van Die LE, Verweij PE, Mavinkurve-Groothuis A (2008) Disseminated aspergillosis in an adolescent with acute lymphoblastic leukemia. Pediatr Blood Cancer 51(3):423–426
Solak Y, Atalay H, Nar A, Ozbek O, Turkmen K, Erekul S, Turk S (2011) Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis. Transpl Infect Dis 13(2):178–181, Epub 2010 Aug 25
Erdem H, Uzunlar AK, Yildirim U, Yildirim M, Geyik MF (2011) Diffuse infiltration of Aspergillus hyphae in the thyroid gland with multinodular goiter. Indian J Pathol Microbiol 54:814–816
Kishi Y, Negishi M, Kami M, Hamaki T, Miyakoshi S, Ueyama J, Morinaga S, Mutou Y (2002) Fatal airway obstruction caused by invasive aspergillosis of the thyroid gland. Leuk Lymphoma 43(3):669–671
Mori T, Matsumura M, Yamada K, Irie S, Oshimi K, Suda K, Oguri T, Ichinoe M (1998) Systemic aspergillosis caused by an aflatoxin-producing strain of Aspergillus flavus. Med Mycol 36:107–112
Kalina PH, Campbell RJ (1991) Aspergillus terreus endophthalmitis in a patient with chronic lymphocytic leukemia. Arch Ophthalmol 109(1):102–103
Keane WM, Potsic WP, Perloff LJ, Barker CF, Grossman RA (1978) Aspergillus thyroiditis. Otolaryngology 86(5):ORL-761–ORL-765
Cooper DS (2003) Hyperthyroidism. Lancet 362(9382):459–468
Ostrosky-Zeichner L, Marr KA, Rex JH, Cohen SH (2003) Amphotericin B: time for a new “gold standard”. Clin Infect Dis 37:415–425
Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de Pauw B; Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415
Marr KA, Boeckh M, Carter RA, Kim HW, Corey L (2004) Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 39:797–802
Hori A, Kami M, Kishi Y, Machida U, Matsumura T, Kashima T (2002) Clinical significance of extra-pulmonary involvement of invasive aspergillosis: a retrospective autopsy-based study of 107 patients. J Hosp Infect 50:175–182
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Nguyen, J., Manera, R. & Minutti, C. Aspergillus thyroiditis: a review of the literature to highlight clinical challenges. Eur J Clin Microbiol Infect Dis 31, 3259–3264 (2012). https://doi.org/10.1007/s10096-012-1704-9
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DOI: https://doi.org/10.1007/s10096-012-1704-9