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Recurrent acute suppurative thyroiditis in a child: case report
1Department of Pediatrics, Tri-Service General Hospital, and National Defense Medical Center, Taipei, Taiwan, ROC.
Insights
A pediatric neck mass and fever were treated with antibiotics and drainage. A persistent infection revealed a left pyriform sinus fistula, successfully treated surgically.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Endocrinology
Background:
- Pediatric neck masses can present with infectious symptoms.
- Thyroid dysfunction may accompany infectious processes.
Observation:
- A 23-month-old girl developed fever and a neck mass post-URI.
- Initial treatment included drainage and antibiotics for suspected thyroiditis.
- Recurrence of symptoms led to further investigation.
Findings:
- Thyroid aspirate cultures grew mixed flora, including streptococci and Prevotella spp.
- Elevated inflammatory markers (ESR, CRP) and impaired thyroid function were noted.
- A left pyriform sinus fistula was identified as the underlying cause.
Implications:
- Pyriform sinus fistula should be considered in pediatric neck infections, especially recurrent ones.
- Multidisciplinary management involving infectious disease, surgery, and endocrinology is crucial.
- Prompt diagnosis and surgical correction of congenital fistulas can prevent recurrent infections.
Abstract:
A 23-month-old girl presented with a history of persistent fever and growing left anterior neck mass following an upper respiratory tract infection. Laboratory studies revealed leukocytosis, elevated levels of the erythrocyte sedimentation rate and C-reactive protein, and a mild impairment of thyroid function. Thyroid scan showed a decreased radioactive iodine uptake of the left thyroid gland. Culture of the thyroid aspirate grew the mixed flora, viridans streptococci, Prevotella spp, and Peptostreptococcus magnus. She was discharged after a surgical drainage and a 14-day course of penicillin-G therapy. Unfortunately, she was readmitted for the resembling problems, the fever and progressing left anterior neck mass 3 months later. Culture of thyroid aspirate also grew the viridans streptococci. She recovered after a 14-day course of penicillin-G therapy. A left pyriform sinus fistula was found by barium esophagogram. A selective operation was performed 8 weeks later.