Fungal Granulomatous Thyroiditis in A Renal Transplant Recipient

Abstract

Fungal granulomatous thyroiditis is a relatively rare entity. Aspergillus is the fungus that most commonly affects the thyroid gland and is generally missed until autopsy. Aspergillus granulomatous thyroiditis diagnosed antemortem and treated in renal transplant recipient patients are extremely rare. We report a 35-year-old female renal transplant recipient who presented with fever, generalized weakness, and loss of appetite; her clinical examination revealed a left thyroid lobe nodule. Fine needle aspiration cytology (FNAC) microscopic examination of the nodule revealed fungal granulomatous thyroiditis. Subsequent examination of FNAC material with special stain Gomori`s Methenamine Silver (GMS), 10% KOH (potassium hydroxide) mounting, and culture confirmed the presence of fungus Aspergillus flavus. This case emphasizes the need for thorough clinical examination and the utility of FNAC in examining thyroid nodules. J Microbiol Infect Dis 2021; 11(4):234-238.

Keywords

• Granulomatous fungal thyroiditis
• Aspergillus species
• Fine-needle aspiration cytology

Kaynakça

1. 1. Pearce N, Farwell AP, Braverman LE. Thyroiditis. New England J Med 2003; 348(26): 2646– 2655.
2. 2. Goldani LZ, Zavascki AP, Maia AL. Fungal thyroiditis: an overview. Mycopathologia 2006;161(3):129–139.
3. 3. De Quervain F. Uber acute, nichteltrige thyroiditis. Archiv fur klinische Chirugie, 1902; 67; 706-714.
4. 4. Olah R, Hajos P, Soos Z, Winkler G. De Quervain thyroiditis. Corner points of the diagnosis. Orv Hetil 2014;155:676–80.
5. 5. Segal H, “Aspergillosis” The New England Journal of Medicine 2009; 360(18):1870–1884.
6. 6. Grekin RH, Cawley EP, Zheutlin B. Generalized aspergillosis. Report of a case. A. M. A. Archives of Pathology 1950; 2(49): 387–392.
7. 7. Hori A, Kami M, Kishi Y, Machida U, Mastumura T, Kashima T. Clinical significance of extra-pulmonary involvement of invasive aspergillosis: A retrospective autopsy-based study of 107 patients. J Hosp Infect 2002;50:175-82.
8. 8. Denning DW, Stevens DA. “Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases, ”Reviews of Infectious Diseases 1990;12(6); 1147–1201.

9. 9. Solak, H. Atalay, A. Nar, et al., “Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis,” Transplant Infectious Disease 2011;13(2);178–181.
10. 10. Su Ho Kim, Jee Young Kim, Woo Chan Park, Mee Kyung Kim,Tae Jung Kim. Sequential Sonographic Features of Primary Invasive Aspergillosis Involving Only the Thyroid Gland: A Case Report and Literature Review. Iran J Radiol 2016;13(1): e27890.
11. 11. Jang KS, Han HX, Oh YH, Paik SS. Aspergillosis of the thyroid gland diagnosed by fine needle aspiration cytology. Acta Cytologica 2004; 48(6):875–876.
12. 12. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006;42(10):1417-27.
13. 13. Das R, Dey P, Chakrabarti A, Ray P. Fine-needle aspiration biopsy in fungal infections. Diagn Cytopathol 1997;16(1):31-4.
14. 14. Cicora F, Mos F, Paz M, Roberti J. Successful treatment of acute thyroiditis due to Aspergillus spp. in the context of disseminated invasive aspergillosis in a kidney transplant patient 2013; 33(4):443-622.
15. 15. Estrada C, Desai A, Chirch L, Suh H, Seidman R, Darras F, et al. Invasive aspergillosis in a renal transplant recipient successfully treated with interferon gamma. Case Rep Transplant 2012: 493758.