PMC4835738_01
A 29-year-old woman with SLE complaining of fever and neck mass and neck mass. A, Transverse and B, Longitudinal sonography shows enlarged right thyroid gland with internal ill-defined hypoechogenic lesion (arrows); C, Color Doppler exam reveals decreased to absent flow in the affected areas of the right thyroid gland; D, Transverse image of left thyroid gland shows unremarkable findings.
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There was no evidence of enlarged cervical lymph nodes (Figure 1).
Follow-up sonography two weeks later showing significant enlargement of both thyroid lobes. A and B, Transverse image shows subcapsular distribution of the irregular and hypoechogenic lesions (arrowheads); C, Longitudinal image shows enlarged thyroid gland with lobulating contour.
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The entire thyroid gland showed irregular hypoechogenicity along the subcapsular region with isoechogenicity in the central portion (Figure 2).
Technetium-99m pertechnetate thyroid scan shows large photon defects of both thyroid glands (arrowheads).
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On scintigraphy, both thyroid glands were noted as large photon defect (Figure 3).
Photomicrograph (original magnification 400; methenamine silver staining) revealed fungal hyphae in a background of necrosis. Individual hyphae with dichotomous 45 degree branching and septation is characteristic of Aspergillus sp.
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Histopathological examination and staining of the surgical specimen with methenamine silver revealed extensive necrotic tissue with many fungal yeast and hyphae characteristic of Aspergillus species (Figure 4).