[Thyroid abscess caused by Salmonella enteritidis]

A 70-year-old diabetic woman with a nodular goitre developed a swelling in the right neck, increasing over two weeks, as well as fever (38.2 degrees C), increased tendency towards sweating, finger tremors and pain on swallowing. Ultrasound examination of the thyroid raised the suspicion of an abscess, 3.5 x 1.5 cm, at the upper pole of the right thyroid lobe. Material obtained by fine-needle puncture grew Salmonella enteritidis. There have been no symptoms of gastroenteritis at any time. Stool and sputum cultures and nasopharyngeal swabs revealed the sites from which haematogenous spread had come. The abscess regressed (as monitored by ultrasound) within four weeks during intravenous treatment with 1,600 mg/d sulphamethoxazole and 320 mg/d trimethoprim (antibiotics determined by drug sensitivity tests) and after several ultrasound-directed needle punctures. Initially manifest hyperthyroidism (fT4: 3.4 ng/dl; basal TSH: 0.03 microU/l) regressed during the treatment without antithyroid treatment. The patient has been symptom-free for 6 months.