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Aspergillus Thyroiditis after Allogeneic Hematopoietic Stem Cell Transplantation.

Ataca P, Atilla E, Saracoglu P, Yilmaz G, Civriz Bozdag S, Toprak SK, Yuksel MK, Ceyhan K, Topcuoglu P - Case Rep Hematol (2015)

Bottom Line: Early management is essential to prevent high mortality.The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis.He was successfully treated by amphotericin B.

View Article: PubMed Central - PubMed

Affiliation: Ankara University School of Medicine, Department of Hematology, Ankara, Turkey.

ABSTRACT
Aspergillus thyroiditis is a rare disorder detected in immunocompromised patients during disseminated infections. Early management is essential to prevent high mortality. A 61-year-old allogeneic stem cell male recipient presented with painful thyroid nodular enlargement. He had low TSH and low free T4 levels. The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis. He was successfully treated by amphotericin B.

No MeSH data available.


Related in: MedlinePlus

(a) 45-degree angle branching fungal hyphaes within a necroinflammatory background (May Grünwald Giemsa Stain, ×400). (b) Septated and branching fungal hyphaes consistent with aspergillosis (Grocott Methenamine Silver stain, ×400).
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fig1: (a) 45-degree angle branching fungal hyphaes within a necroinflammatory background (May Grünwald Giemsa Stain, ×400). (b) Septated and branching fungal hyphaes consistent with aspergillosis (Grocott Methenamine Silver stain, ×400).

Mentions: A 61-year-old male patient was diagnosed with stage 1 mycosis fungoides in January 2010 and was treated with photochemotherapy, interferon, extracorporeal photopheresis (ECP), and Bexarotene. After 44 months of diagnosis, the patient presented with inguinal lymph node enlargement. The biopsy results revealed large cell transformation. The patient underwent allogeneic stem cell transplantation of peripheral blood from 9/10 HLA-matched unrelated donors with a reduced intensity (fludarabine, cyclophosphamide, ATG, and TBI) conditioning regimen. Posttransplant graft versus host disease (GVHD) prophylaxis was administered in the form of methotrexate (10 mg/m2; days 1, 3, 6, and 11) and cyclosporine (3 mg/kg/day). Thirty-two days after transplantation, the patient was admitted to the hospital with acute gastrointestinal (grade 1) and skin GVHD (grade 2). As a result, methylprednisolone 2 mg/kg/day was initiated with a tapering program in addition to cyclosporine and mycophenolate mofetil. Steroid induced diabetes mellitus occurred during follow-up. At 20 months of follow-up, the patient developed chronic extensive GVHD, and, under immunosuppressive therapy and ECP, he presented with fatigue, cough, and fever. Aspergillus fumigatus was isolated in sputum culture concomitant with high serum galactomannan antigen levels (1.99 S/CO). CT scan of the thorax revealed 25 × 20 mm nodules in the left medial lower lobe. We replaced the voriconazole treatment with liposomal amphotericin B (5 mg/kg) due to severe hallucinations. However, after one week of treatment, painful thyroid nodular enlargement was detected. The following thyroid function tests were performed: TSH: 0.29 mU/L (0.3–5 mU/L), free T4: 0.3 ng/dL (0.7–2.1 ng/dL), and free T3: 0.2 ng/dL (0.2–6.5 ng/dL) showing sick euthyroid syndrome. The thyroid ultrasound showed a 5.5 × 4 × 3 cm hypoechoic nodule. Fine needle aspiration (FNA) indicated suppurative Aspergillus thyroiditis (Figures 1(a) and 1(b)). With amphotericin B (5 mg/kg) treatment, the patient's serum galactomannan antigen levels were decreased to 1.74, 0.45, 0.31, and 0.1. The pulmonary nodules disappeared and the thoracic nodules regressed and the patient was stable after 6 weeks of treatment with normal thyroid function tests.


Aspergillus Thyroiditis after Allogeneic Hematopoietic Stem Cell Transplantation.

Ataca P, Atilla E, Saracoglu P, Yilmaz G, Civriz Bozdag S, Toprak SK, Yuksel MK, Ceyhan K, Topcuoglu P - Case Rep Hematol (2015)

(a) 45-degree angle branching fungal hyphaes within a necroinflammatory background (May Grünwald Giemsa Stain, ×400). (b) Septated and branching fungal hyphaes consistent with aspergillosis (Grocott Methenamine Silver stain, ×400).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660011&req=5

fig1: (a) 45-degree angle branching fungal hyphaes within a necroinflammatory background (May Grünwald Giemsa Stain, ×400). (b) Septated and branching fungal hyphaes consistent with aspergillosis (Grocott Methenamine Silver stain, ×400).
Mentions: A 61-year-old male patient was diagnosed with stage 1 mycosis fungoides in January 2010 and was treated with photochemotherapy, interferon, extracorporeal photopheresis (ECP), and Bexarotene. After 44 months of diagnosis, the patient presented with inguinal lymph node enlargement. The biopsy results revealed large cell transformation. The patient underwent allogeneic stem cell transplantation of peripheral blood from 9/10 HLA-matched unrelated donors with a reduced intensity (fludarabine, cyclophosphamide, ATG, and TBI) conditioning regimen. Posttransplant graft versus host disease (GVHD) prophylaxis was administered in the form of methotrexate (10 mg/m2; days 1, 3, 6, and 11) and cyclosporine (3 mg/kg/day). Thirty-two days after transplantation, the patient was admitted to the hospital with acute gastrointestinal (grade 1) and skin GVHD (grade 2). As a result, methylprednisolone 2 mg/kg/day was initiated with a tapering program in addition to cyclosporine and mycophenolate mofetil. Steroid induced diabetes mellitus occurred during follow-up. At 20 months of follow-up, the patient developed chronic extensive GVHD, and, under immunosuppressive therapy and ECP, he presented with fatigue, cough, and fever. Aspergillus fumigatus was isolated in sputum culture concomitant with high serum galactomannan antigen levels (1.99 S/CO). CT scan of the thorax revealed 25 × 20 mm nodules in the left medial lower lobe. We replaced the voriconazole treatment with liposomal amphotericin B (5 mg/kg) due to severe hallucinations. However, after one week of treatment, painful thyroid nodular enlargement was detected. The following thyroid function tests were performed: TSH: 0.29 mU/L (0.3–5 mU/L), free T4: 0.3 ng/dL (0.7–2.1 ng/dL), and free T3: 0.2 ng/dL (0.2–6.5 ng/dL) showing sick euthyroid syndrome. The thyroid ultrasound showed a 5.5 × 4 × 3 cm hypoechoic nodule. Fine needle aspiration (FNA) indicated suppurative Aspergillus thyroiditis (Figures 1(a) and 1(b)). With amphotericin B (5 mg/kg) treatment, the patient's serum galactomannan antigen levels were decreased to 1.74, 0.45, 0.31, and 0.1. The pulmonary nodules disappeared and the thoracic nodules regressed and the patient was stable after 6 weeks of treatment with normal thyroid function tests.

Bottom Line: Early management is essential to prevent high mortality.The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis.He was successfully treated by amphotericin B.

View Article: PubMed Central - PubMed

Affiliation: Ankara University School of Medicine, Department of Hematology, Ankara, Turkey.

ABSTRACT
Aspergillus thyroiditis is a rare disorder detected in immunocompromised patients during disseminated infections. Early management is essential to prevent high mortality. A 61-year-old allogeneic stem cell male recipient presented with painful thyroid nodular enlargement. He had low TSH and low free T4 levels. The thyroid ultrasound showed a hypoechoic nodule; biopsy indicated suppurative Aspergillus thyroiditis. He was successfully treated by amphotericin B.

No MeSH data available.


Related in: MedlinePlus