Thyroid Abscess: Challenges in Diagnosis and Management.

Area of Science:

• Endocrinology
• Infectious Diseases
• Radiology

Background:

• Thyroid abscess is an uncommon infectious pathology due to the thyroid's natural resistance.
• Acute suppurative thyroiditis is a rare endocrine emergency, often occurring in immunocompromised individuals.
• Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly recognized pathogen in severe infections.

Purpose of the Study:

• To report a rare case of MRSA thyroid abscess in an immunocompromised patient.
• To highlight diagnostic challenges, including inconclusive initial imaging.
• To emphasize the potential for delayed diagnosis of acute suppurative thyroiditis.

Main Methods:

• Case report of a 48-year-old woman with AIDS presenting with fever and neck swelling.
• Initial laboratory tests and imaging (CT, ultrasound) were inconclusive.
• Repeat contrast-enhanced CT identified thyroid and retropharyngeal abscesses requiring drainage.

Main Results:

• The patient presented with fever, tender neck swelling, and MRSA bacteremia.
• Initial imaging was negative, leading to a potential misdiagnosis of subacute thyroiditis.
• Multiloculated abscesses were confirmed on repeat CT, necessitating emergent drainage.

Conclusions:

• Acute suppurative thyroiditis can be a life-threatening condition, particularly in immunocompromised patients.
• Early imaging may not detect thyroid abscesses, underscoring the need for clinical suspicion.
• This case highlights a rare instance of MRSA causing suppurative thyroiditis, emphasizing the importance of prompt diagnosis and management.