Surprise struma. Suppurative thyroiditis found by In-111 WBC imaging.

A 53-year-old woman with a long history of severe systemic lupus erythematosus immunosuppressed by therapeutic glucocorticosteroid therapy became febrile and severely ill. History and physical examination failed to Indicate a source of infection. Cultures of body fluids were obtained and blood cultures grew Aspergillis nigricans; broad spectrum antibacterial and antifungal antibiosis was begun. An In-111 WBC scan showed thyroid localization, and a CT scan showed a goiter with multiple thyroid abscesses. Needle aspiration culture material from the thyroid was sterile by microscopy and culture. The patient recovered uneventfully