Thyroid Abscess in Immuno Compromised Patient: A Case ReportCorrespondence Address :
Dr. Y.P. Lamani
Department of Surgery
SN Medical College, Navanagar, Bagalkot
Thyroid abscess is a rare condition of the thyroid gland. The ability of thyroid gland is to resist infection which is well known and the infection in thyroid gland is rare, particularly so with the advent of widespread usage of antibiotics. Thyroid abscess represents only 0.1 to 0.7% of surgically treated thyroid pathologies. We report here a case of adult female with HIV infection who presented with thyroid abscess.
Abscess, Staphyloccocal aureus, Thyroditis
Acute suppurative thyroditis(AST) leading to thyroid abscess is a rare clinical entity. AST affects specially patients with pre-existing thyroid gland pathology and in childhood it is associated with local anatomic defects. Because of its rarity and unusual clinical features, the diagnosis of thyroid abscess is often delayed. Thyroid abscess is infrequently encountered condition with a rarity that is attributed to anatomic and physiologic characteristics of the gland that imparts a unique quality of infection of resistance. When discovered a thyroid abscess it presents as acutely as a painful swelling. The differential diagnosis for a painful thyroid is limited, with sub-cute and chronic thyroiditis being the most often encountered process.
A 28-year old female presented with an enlarging painful neck swelling of one month duration. There was a history of mild to moderate degree fever and odonophagia since the onset of the swelling. Pain was described as constant and radiating to the occipital region. On admission patient was febrile, tachacycardia but no evidence of respiratory distress. Examination of the neck reveled a swelling occupying in the region of thyroid more prominent on the right than on the left. The swelling was tender and fluctuant, movement with deglutition was present and there was no movement with protrusion of tongue. No cervical lymphadenopathy was found. Laboratory investigations revealed laeukocyte count of more than 15000 with 80% of polymorphs; haemoglobin of 9% with HIV infection.USG neck demonstrated a cystic swelling in the right lobe of the thyroid suggestive of thyroid abscess. Needle aspiration of the swelling obtained thick yellow pus and culture yielded Staphylococcal aureus, thyroid function test was normal. Patient underwent ultrasound guided byaspiration with wide bore needle, and given intravenous antibiotics according to the culture sensitivity report. Patient was followed up after one month there was gross regression in the size of the swelling and pain.
Thyroid abscess is an infrequently encountered condition, with a rarity that is attributable to the anatomic and physiologiccharacteristics of the gland that imparts a unique quality of infection resistance (1). The remarkable resistance of the thyroid gland to infection is attributable to many factors. A prosperous lymphatic and vascular supply, well developed capsule, high iodine content of the gland havevarious mechanisms suggested to account for this relative resistance to infection (2).
Abscess formation of thyroid most commonly arises in pediatric population in the setting of anatomic anomalies of the hypopharyngeal region, leading to the development of a pyriform sinus fistula. In the adult population, multiple etiologies have been proposed. Abscess development secondary to direct trauma from foreign bodies, such as fine needle aspiration, fish bone and chicken bone penetration have been described, as well as extension from neighboring anatomic structures (3),(4),(5). However hematogenous spreading from a distant site is considered to be the most common cause of infection,eventhough the exact infectious source or pathology is frequently unknown (6). The most common causative organisms have historically been Staphylococci and Streptococci species and cultures are moreoften polymicrobials,other organisms isolated such as Acinatobacter, Mycobacterium, Coccidiodes, Pseudomonas, Salmonella, Eikenella, Clostridium, Nocordia, Pnemocystis carnii, Hemophilus and Candida species have been identified, although they are most commonly associated with immunosuppressed patients (6), (8),(9),(10),(11),(12),(13),(14),(15),(16). Acute suppurative thyroiditis has also been associated with immunsuppression, especially human immune-deficiency virus (15). Patients infected with HIV, however still develop Mycobacterial and fungal thyroid infection with some regularity. AST has been associated with transient hyperthyroidism and was caused by Pasteurella multocida (7).
Because of its rarity the incidence of thyroid abscess formation is difficult to identify. That data are equivocal regarding whether thyroid abscesses occur more frequently in men or women. Hazard et al (3) observed a more common occurance in the women in the age range of 20-40 years, where as large reviews by Yu et al (17) and Burger et al (18) both revealed a more uniformed distribution among the sexes. Acute suppurative thyroiditis responds well to antibiotics (Intravenous) with or without incision drainage of the abscesses and rarely causes external fistula. Our patient was a female aged 28 years with immunocompromised state presented with painful swelling in the region of thyroid, underwent USG guided aspiration of the pus and culture showed Staphylococcal aureus and she was managed with intravenous antibiotics for 7days. Follow up done after one month there was complete regression of the swelling and pain.
FINANCIAL OR OTHER COMPETING INTERESTS: NONE.
Date of Submission: Nov 02, 2011
Date of Peer Review: Dec 11, 2011
Date of Acceptance: Dec 22, 2011
Date of Publishing: Feb 15, 2012
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