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ABSTRACT: Objective:Nocardia is an opportunistic organism that usually infects immunocompromised patients. However, suppurative thyroiditis is a rare complication of nocardiosis.Methods: We report a case of Nocardia thyroiditis in an immunosuppressed patient following renal transplant.Results: A 45-year-old man presented with worsening diffuse muscle pain, weakness, and subjective fever. He had a significant history of recent renal transplant with immunosuppression at the time of presentation. Mild swelling was noted in the right submandibular area, and multiple papules were noted on the skin. Although pulmonary exam revealed no abnormalities, computed tomography revealed numerous bilateral small pulmonary nodules and multiple hypodense thyroid nodules. A positron emission tomography scan showed hypermetabolic activity in the mediastinum, lungs, thyroid, and skeletal muscles. During a right-thyroid lobectomy to rule out post-transplant lymphoproliferative disease, purulent discharge from a ruptured cyst was identified. Histopathology revealed granulomatous, focally suppurative thyroiditis and filamentous microorganisms morphologically resembling Nocardia. The pathological and clinical findings in the thyroid, lungs, skin, and nervous system correlated with disseminated nocardiosis.Conclusion:Nocardia thyroiditis is a rare presentation of disseminated nocardiosis. Diagnosis in our case was achieved upon analysis of unusual purulent drainage during thyroid lobectomy for suspicion of post-transplant lymphoma. Thyroidectomy may be considered in resistant and recurrent Nocardia thyroiditis following surgical drainage and antibiotic management. Although most cases of suppurative thyroiditis are of bacterial origin, this case suggests the importance of considering Nocardia as a possible etiological agent of suppurative thyroiditis, particularly in an immunocompromised patient with additional pulmonary, cutaneous, and nervous system manifestations.

ABSTRACT: Objective: This case report will describe the first adjunct use of directly measuring the concentration of human chorionic gonadotropin (HCG) in fine-needle aspiration (FNA) washout for diagnosing metastatic non-semi-nomatous germ cell tumor (NSGCT) of the testicle in a patient with cervical lymphadenopathy.Methods: We present the clinical, laboratory, imaging, and pathologic findings, along with a review of the literature.Results: A 23-year-old, otherwise healthy man who first presented with left testicular discomfort and swelling was diagnosed with NSGCT after undergoing a left orchiectomy. A few years later, the patient presented with a 2-cm left supraclavicular mass. Upon ultrasound of the thyroid and soft tissues of the neck, a 1-cm left thyroid nodule was revealed, as well as a 2.8-cm left supraclavicular lymph node, which was cystic in nature and worrisome for metastatic disease given the patient's history of metastatic NSGCT. The results of the FNA of the left thyroid nodule were benign, however the results from the supraclavicular mass were nondiagnostic. Due to the nondiagnostic FNA results, another aspiration with cytopathology and HCG evaluation washout was performed. The HCG aspirate came back with a value of 162 mIU/mL, despite the patient's negative serum HCG results.Conclusion: This case demonstrates a novel way to diagnose metastatic testicular germ cell tumors utilizing FNA-HCG washout. Future prospective trials are needed to further elucidate this important finding.Abbreviations: FNA fine-needle aspiration HCG human chorionic gonadotropin NSGCT non-seminomatous germ cell tumor TG thyroglobulin