Infection of the thyroid gland with Coccidioides immitis, the causative agent of coccidioidomycosis, is very rarely recognized antemortem. We report 2 recent cases, one immunosuppressed by corticosteroid treatment of sarcoidosis and the other without any recognized impairment of host defenses. In the first case, thyroid gland involvement was but 1 indication of disseminated infection. In the second case, the patient appeared to have autoimmune thyrotoxicosis without clinical evidence of coccidioidomycosis elsewhere. Although historical autopsy studies have indicated that coccidioidal involvement of the thyroid gland can infrequently occur as part of fatal disseminated infection, to our knowledge only 2 other cases of infection detected during life have been reported. Optimal treatment of this rare complication of coccidioidomycosis is uncertain.
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Patient 1. Computed tomogram of the neck, showing a peripherally enhancing irregular abscess (white arrow) anterior to the thyroid isthmus, with extension into the left lobe of the thyroid gland (black arrow). Several small, peripherally enhancing lucencies in the lateral aspect of the right thyroid lobe are also evident.
Patient 2. Top, Photomicrograph of a portion of the resected thyroid gland, demonstrating granulomatous inflammation at the edge of thyroid parenchymal tissue. Bottom, Several spherules characteristic of Coccidioides immitis can be seen (arrows) (hematoxylin-eosin, original magnification ×40 [top], ×200 [bottom]).
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