Pneumocystis carinii Thyroiditis
Report of Three Cases and Review of the Literature
Pneumocystis carinii infection of the thyroid gland has previously been described in only four living patients with acquired immunodeficiency syndrome, three of whom had been receiving inhaled pentamidine prophylaxis against P carinii pneumonia. We treated three additional patients with P carinii thyroid involvement, all of whom were receiving aerosolized pentamidine. Two of our patients presented with clinical features suggestive of subacute granulomatous thyroiditis. The diagnosis of P carinii in our patients, as well as in the previously described patients, was established by thyroid fine-needle aspiration and Gomori’s silver methenamine stains. The recent emergence of P carinii infection of the thyroid gland is likely related to the use of inhaled pentamidine prophylaxis, which appears to predispose to the development of extrapulmonary pneumocystosis. Clinicians need to be aware of the possibility of P carinii thyroiditis and should use aspiration and Gomori’s methenamine silver staining in studying patients with the acquired immunodeficiency syndrome who have a painful (or other unexplained) thyroid mass so as to be able to initiate prompt and appropriate therapy.
In the thyroid glands of these three with thyroid nodules there was atypical TB and Kaposi’s sarcoma as well as Pneumocystis carinii.
(Arch Intern Med. 1993;153:393-396)
Onset of HIV-related infections in relation to CD4 cellcounts Less than 400CD4 Cell count Less than 200Less than 50Bacterial infections Pneumocystis carinii Cytomegalovirus Urinary tract infec- Toxoplasmosistions Shingles Herpes simplexOral and vaginalcandidiasis Tuberculosis Coccidiomycosis Cryptosporidiosis Isospora Mycobacterium avium Cryptococcus Aspergillius Histoplasmosis