Aspergillus Suppurative Thyroiditis in the Setting of Hypogammaglobulinaemia.

Thyroiditis is a condition characterised by the inflammation of the thyroid gland. Most cases of suppurative thyroiditis are caused by aerobic bacteria and present acute onset of symptoms. Hypogammaglobulinaemia associated with suppurative thyroiditis is extremely rare. This case relates to a diagnosis of Aspergillus suppurative thyroiditis in 78-year-old female patient in a setting of hypogammaglobulinaemia. The patient initially presented with dyspnoea following a recent diagnosis of chronic obstructive pulmonary disease. She developed worsening thyroid pain and swelling, and lab results confirmed hyperthyroidism. Imaging revealed a multinodular goitre, and fine-needle aspiration confirmed Aspergillus fumigatus. After discontinuing antibiotics, voriconazole was started. Due to immunologic workup showing low IgG, intravenous immunoglobulin was administered. Symptoms improved after a 12-week course. This case highlights the importance including differential diagnosis of fungal infection in patients present with acute suppurative thyroiditis and significance of conducting a comprehensive assessment for underlying immunodeficiency.

Learning points: Although rare, fungal pathogens such as Aspergillus should be considered in patients with acute neck pain, swelling and signs of systemic infection, particularly in immunocompromised individuals.For infections caused by uncommon pathogens, immunology deficiency evaluation is important.Given the high mortality associated with Aspergillus thyroiditis, early identification and prompt treatment are essential to improved patient outcomes.