title: Suppurative thyroiditis due to aspergillosis: a case report.
abstract: BACKGROUND
  Aspergillus, a nosocomial agent, is the most common fungal cause of suppurative thyroiditis. Most patients with Aspergillus thyroiditis have disseminated infection, primarily with lung compromise. Late diagnosis and treatment, severity of immunosuppressive state and thyroid hormone overload contribute to extremely high mortality rates.
  
  
  METHODS
  We describe a 20-year-old Caucasian man receiving corticosteroid suppression therapy for systemic lupus erythematosus. He presented persistent fever with neck pain and pulmonary infection. Piperacillin/tazobactam was initiated but after 2 days he developed hypoxemia, vascular shock, severe anemia, lymphopenia, and high C-reactive protein. Thyroid ultrasound revealed well-defined hypoechogenic clusters in both lobes and laboratorial thyrotoxicosis but low triiodothyronine concentration. A purulent substance was obtained on fine needle aspiration and drained. Amphotericin B and fluconazole were added but he had unfavorable evolution and died. Aspergillus fumigatus was defined only 2 days after his death.
  
  
  CONCLUSIONS
  This case serves to alert clinicians to the possibility of infectious thyroiditis and reinforces the high risk of aspergillosis in immunocompromised patients. Therefore, management including voriconazole as first-line treatment or amphotericin B, in association with broad-spectrum antibiotic therapy, should be adopted to improve treatment outcome.
authors.affiliation: Unidade de Tireoide-Disciplina de Endocrinologia e Metabologia, Avenida Dr Arnaldo 455 Sala 4305, 01246-903 Sao Paulo, SP, Brazil. suemimar@usp.br.
authors.forename: Suemi
authors.initials: S
authors.lastname: Marui
authors.forename: Ariella Cabral
authors.initials: AC
authors.lastname: de Lima Pereira
authors.forename: Raquel Maria
authors.initials: RM
authors.lastname: de Araújo Maia
authors.forename: Eduardo Ferreira
authors.initials: EF
authors.lastname: Borba
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D013969:Thyroiditis, Suppurative / Q000209:etiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B