Abstract
BackgroundPyrexia of unknown origin is a difficult and challenging problem for the physician. Endocrine disorders, such as subacute thyroiditis, rarely present with pyrexia of unknown origin. Subacute thyroiditis can have a broad spectrum of clinical presentations including fever and biochemical thyrotoxicosis without overt signs or symptoms.Case presentationA previously healthy 42-year-old Sri Lankan Sinhalese man was extensively investigated for a prolonged fever of 3 weeks with high inflammatory markers. He had mild tenderness over his neck with cervical lymphadenopathy with no thyrotoxic symptoms or signs. An ultrasound scan revealed an enlarged thyroid with increased vascularity and he had suppressed thyroid-stimulating hormone with elevated free thyroxine and free triiodothyronine hormone levels. Fine-needle aspiration cytology confirmed thyroiditis. He responded well to low-dose steroids.ConclusionSubacute thyroiditis should be considered in the diagnostic workup of pyrexia of unknown origin even in the absence of overt toxic symptoms of thyroid hormone excess.
Highlights
Pyrexia of unknown origin is a difficult and challenging problem for the physician
We report the case of a Sri Lankan Sinhalese man presenting with a fever for 3 weeks without neck pain or thyrotoxic symptoms diagnosed as having subacute thyroiditis and his recovery following a course of low-dose steroids
We describe a case of Pyrexia of unknown origin (PUO) due to subacute thyroiditis
Summary
Pyrexia of unknown origin (PUO) is a diagnostic challenge for the treating physician. Subacute thyroiditis is a rare self-limiting inflammatory condition probably viral in origin with a genetic predisposition It commonly presents with a painful swelling of the neck and mild thyrotoxic symptoms with raised inflammatory markers and rarely with other atypical clinical features such as lymphadenopathy. We report the case of a Sri Lankan Sinhalese man presenting with a fever for 3 weeks without neck pain or thyrotoxic symptoms diagnosed as having subacute thyroiditis and his recovery following a course of low-dose steroids. A follow-up was arranged to review his thyroid profile in 6 months
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