Acute spontaneous suppurative thyroiditis caused by Eikenella corrodens presented with thyrotoxicosis.

Pınar Akhanlı,Güleser Saylam,Sema Hepşen,Madamin Badirshaev,Mehmet Hakan Korkmaz,Seyit Murat Bayram,Erman Çakal,Ömer Bayır

doi:10.31744/einstein_journal/2020rc5273

Pınar Akhanlı, Güleser Saylam + Show 6 more

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https://doi.org/10.31744/einstein_journal/2020rc5273

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Abstract

ABSTRACTAcute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

Highlights

Acute suppurative thyroiditis (AST) is an extremely rare and life-threatening endocrine emergency, with an incidence of 0.1% to 0.7% in all thyroid diseases.[1]. Thyroid hormone levels are generally normal in AST, but thyrotoxicosis is a rare condition.[2]. Generally, AST develops secondary to systemic diseases, immunodeficiency conditions or traumatic events, such as fine needle aspiration (FNAB), whereas spontaneous AST is quite rare.[2]. In this case report, we aimed to discuss a patient who presented with thyrotoxic symptoms to our clinic, and was diagnosed with spontaneous AST
Because of the high vascularization and lymphatic drainage, high iodine concentration and encapsulation, the thyroid gland is resistant to infections and acute thyroid gland infections are extremely rare.[2]. Acute suppurative thyroiditis may develop due to direct extension of adjacent regions, retropharyngeal abscess, penetrating traumas, thyroid FNAB, intravenous drug usage, rupture or perforation of esophagus, or secondary infections due to immunosuppressive diseases.[1,2] Pyriform sinus fistula is a rare condition which is resulting from failure of intrauterine obliteration of third and fourth branchial arch embriologically
We reported our diagnosis and treatment approach to a case of spontaneous acute suppurative thyroiditis, which is a very rare disease, accompanied by thyrotoxicosis and caused by Eikenella corrodens

Summary

Introduction

Acute suppurative thyroiditis (AST) is an extremely rare and life-threatening endocrine emergency, with an incidence of 0.1% to 0.7% in all thyroid diseases.[1]. A 31-year-old male patient without any history of chronic diseases, thyroid pathologies or previous neck surgery, was admitted to the ear-nose-throat outpatient clinic with the complaints of neck pain, dysphagia, swelling and redness on midline neck region, fever, and palpitations that started 10 days ago. He had tremor on hands and was generally agitated. Otolaryngology examination revealed swelling, redness, and tenderness of approximately 7cm, especially in the area corresponding to the thyroid region (Figure 1) In his systemic examination, breath sounds were normal, tachycardia was present, but no pathological sounds or murmurs were detected.

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