Metastatic Thyroid Abscess: A Rare Presentation of Catheter-related Bloodstream Infection in an End-Stage Kidney Disease Patient on Hemodialysis.

Abstract

Dear Editor, Over two-third of patients initiated on hemodialysis (HD) in India have temporary catheters as the initial venous access.[1] Bloodstream infections caused by infection of the catheters can lead to metastatic complications like infective endocarditis and septic arthritis.[2] We report a case of acute suppurative thyroiditis in an end-stage kidney disease (ESKD) patient with a history of prolonged use of non-tunneled catheter. A 35-year-old male had been undergoing HD through a right internal jugular non-tunneled catheter for three months. He presented to us with complaints of high fever, chills and rigors, swelling of the neck, and dysphagia for 10 days. Local examination revealed a large, tender, warm, and fluctuant anterior neck mass [Figure 1a].Figure 1: (a) A patient having diffuse painful neck swelling on admission. (b) Contrast-enhanced computed tomography of the neck showing multiple hypodense collections in both lobes of the thyroid and extending to the retropharyngeal space. (c) Resolution of swelling of the same patient after treatmentContrast-enhanced computed tomography of the neck revealed multiple loculated hypodense collections, approximating around 90 cc and showing enhancement of walls and septa in both lobes of the thyroid: these were suggestive of acute suppurative thyroiditis [Figure 1b]. Blood cultures sent from the catheter, peripheral blood, and pus culture from the thyroid abscess grew methicillin-resistant Staphylococcus aureus (MRSA). Henceforth, a diagnosis of metastatic thyroid abscess secondary to catheter-related bloodstream infection was considered. The catheter was removed followed by ultrasound-guided drainage of the abscess and antibiotics as per culture sensitivity. There was complete resolution of the abscess [Figure 1c]. Metastatic infections have been observed in approximately 5%–10% of patients undergoing HD through central venous catheters.[3] The tough capsule, high iodine content, and good lymphatic drainage make the thyroid gland resistant to infections.[4] We could find only one other case[5] that reported acute suppurative thyroiditis in an ESKD patient. CRBSI presenting as thyroid abscess is extremely rare and should always be suspected in any HD patient with painful neck swelling. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.