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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis

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A Rare Presentation of Acute Suppurative Thyroiditis.

Alexandra D Blumer¹, David A Bloom², Jodi S Ehrmann¹

¹Department of Pediatrics.

|November 5, 2024

Summary

A rare case of acute suppurative thyroiditis in a teen was caused by herpes simplex virus esophagitis. This led to esophageal perforation, fistula, and sepsis, highlighting a critical diagnostic challenge.

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Area of Science:

Infectious Diseases
Endocrinology
Critical Care Medicine

Background:

Subacute thyroiditis can present with neck pain and hyperthyroidism, often leading to misdiagnosis.
Lemierre syndrome is a serious complication of oropharyngeal infection, characterized by thrombophlebitis of the internal jugular vein.

Observation:

A 17-year-old female presented with neck pain, progressing to hyperthyroidism, then sepsis with multiorgan failure.
Imaging revealed acute suppurative thyroiditis as the source, with direct visualization of an esophageal fistula.

Findings:

Herpes simplex virus esophagitis was diagnosed via esophageal biopsy and immunostaining.
Esophageal perforation and fistula formation were attributed to HSV esophagitis, leading to thyroiditis and sepsis.

Implications:

Highlights the importance of considering rare infectious etiologies in thyroiditis and sepsis.
Emphasizes prompt diagnosis and multidisciplinary management for complex cases involving esophageal perforation and sepsis.
Suggests a potential link between HSV esophagitis and severe thyroidal complications.