Invasive aspergillosis diagnosed by fine-needle aspiration of the thyroid gland

Invasive aspergillosis has been increasingly recognized as causing signific ant morbidity and mortality in immunocompromised patients but has never bee n diagnosed by fine-needle thyroid aspiration. A 24-year-old female with sy stemic lupus erythematosus presented with cough, shortness of breath, and f ever of unknown origin unresponsive to broad-spectrum antibiotics. History and physical examination failed to indicate a source of infection. An In-11 1 white blood cell scan showed thyroid localization. Physical examination r evealed a multinodular goiter with a left dominant nodule. Fine-needle aspi ration biopsy of a thyroid nodule revealed branching hyphae suggestive of A spergillus sp. Despite immediate and aggressive treatment with amphotericin B and fluconazole, the patient died of overwhelming infection.