Histoplasmosis of the thyroid

Fungal infection of the thyroid is rare. Most reported cases have involved Aspergillus, Coccidioides, and Candida species in the setting of disseminat ed disease. Infection of the thyroid with Histoplasma capsulatum is rarely reported as part of disseminated disease, even in geographic areas where hi stoplasmosis is endemic. We report a 52-year-old woman with a previous Hash imoto's disease and non-Hodgkin's lymphoma in which a diffuse enlarged thyr oid gland with a large nodule was the only apparent locus of histoplasmosis . Fine-needle aspiration of the thyroid was an important diagnostic tool in establishing the diagnosis of histoplasmosis of the thyroid. The patient w as initially treated with itraconazole (400 mg/day) for the fungal infectio n and six cycles of chemotherapy for the lymphoma. At a 6-month follow-up e xamination, the patient was doing well an suppressive therapy of itraconazo le (200 mg/day), with no symptoms and with regression of the thyroid nodule and cervical adenopathy.