Thyroid Abscess as a Manifestation of Invasive Aspergillosis in a Chronic Granulomatous Disease Patient

Abstract

Chronic granulomatous disease is a genetic immunodeficiency disease characterised by severe bacterial and fungal infections as well as inflammatory granuloma formations in multiple body sites including the gastrointestinal tract, urinary tract. We present a rare case of fungal thyroid abscess as the sentinel presentation of severe disseminated Aspergillus felis in a chronic granulomatous disease patient. The right thyroid lobe was enlarged with a heterogeneous fluid collection visible on ultrasound, with microbiological analysis demonstrating Aspergillus felis. Combined with other abscesses in the liver and spleen, the clinical picture was consistent with invasive aspergillosis. The patient was treated with antifungal therapy with radiological improvement in the thyroid abscess but was associated with persistent invasive aspergillosis despite multiple therapies, with death 18 months after presentation. Such documented manifestation along with the relative ease to biopsy this radiological finding and facilitate establishing diagnosis may be of use in managing chronic granulomatous disease in the future.